1174810287 NPI number — MRS. COMFORT DUPE BOGUNJOKO RN BSN, MSC

Table of content: MRS. COMFORT DUPE BOGUNJOKO RN BSN, MSC (NPI 1174810287)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174810287 NPI number — MRS. COMFORT DUPE BOGUNJOKO RN BSN, MSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOGUNJOKO
Provider First Name:
COMFORT
Provider Middle Name:
DUPE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN BSN, MSC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174810287
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12217 KINGS ARROW ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOWIE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20721-1943
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-354-1632
Provider Business Mailing Address Fax Number:
240-245-3910

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3115 GEORGIA AVE NW
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20010-2901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-829-1595
Provider Business Practice Location Address Fax Number:
202-829-1812
Provider Enumeration Date:
07/09/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WC0400X , with the licence number:  RN1003995 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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