Provider Demographics
NPI:1265296610
Name:ABOA, BOUSHRA BAMBA
Entity type:Individual
Prefix:
First Name:BOUSHRA
Middle Name:BAMBA
Last Name:ABOA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 PINCHER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-1724
Mailing Address - Country:US
Mailing Address - Phone:346-382-6865
Mailing Address - Fax:
Practice Address - Street 1:2010 PINCHER CREEK DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-1724
Practice Address - Country:US
Practice Address - Phone:346-382-6865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-07
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX346568164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse