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General NPI Number Information
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NPI Number | 1154080802
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Entity Type | Individual
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Provider Name | SOPHIA ETOMI AGBOMAH CRNA
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Gender | Female
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Dates
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Enumeration Date | 12/09/2021
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | MEMORIAL HERMANN 27800 NORTHWEST FWY,
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City | CYPRESS
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State | TX
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Zip | 77433
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Country | US
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Telephone | 346-231-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 7615 LEGACY PINES DR
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City | CYPRESS
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State | TX
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Zip | 77433-2759
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Country | US
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Telephone | 512-704-3595
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 977206
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 152950
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License Number State | TX
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