Provider Demographics
NPI:1881431542
Name:BOUGANG, OCTAVIE
Entity type:Individual
Prefix:
First Name:OCTAVIE
Middle Name:
Last Name:BOUGANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:OCTAVIE JULIETTE
Other - Middle Name:K
Other - Last Name:FONOU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4051 BLUE SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:OH
Mailing Address - Zip Code:45050-2502
Mailing Address - Country:US
Mailing Address - Phone:513-884-7766
Mailing Address - Fax:
Practice Address - Street 1:4051 BLUE SPRINGS DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:OH
Practice Address - Zip Code:45050-2502
Practice Address - Country:US
Practice Address - Phone:513-884-7766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-10
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemaker
No172A00000XOther Service ProvidersDriverGroup - Single Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant