Provider Demographics
NPI:1356185011
Name:BOKATUKA, NOUR ILENDA
Entity type:Individual
Prefix:
First Name:NOUR
Middle Name:ILENDA
Last Name:BOKATUKA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3227 ROESCH BLVD APT B
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45014-4358
Mailing Address - Country:US
Mailing Address - Phone:513-799-1949
Mailing Address - Fax:
Practice Address - Street 1:3227 ROESCH BLVD APT B
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45014-4358
Practice Address - Country:US
Practice Address - Phone:513-799-1949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health