Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | NM 86-182 | NM |
NPI | 1568478279 |
---|---|
Provider Name | Juliane Nichole Bohan |
First Address | Albuquerque, NM 87106-4217 |
Second Address | Albuquerque, NM 87106-4217 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 29/10/2014 |