Healthcare Provider Details

I. General information

NPI: 1609504257
Provider Name (Legal Business Name): JOSIE JEANNE BOHMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2022
Last Update Date: 08/11/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 HEARD AVENUE, BLDG 556 ROOM 127
SCHOFIELD BARRACKS HI
96857
US

IV. Provider business mailing address

334 HEARD AVENUE, BLDG 556 ROOM 127
SCHOFIELD BARRACKS HI
96857
US

V. Phone/Fax

Practice location:
  • Phone: 808-438-5555
  • Fax:
Mailing address:
  • Phone: 808-438-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: