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Individual
SURAYYO BOBODZHANOVA
Active
Individual
SURAYYO BOBODZHANOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
69496
NE
163W00000X
Registered Nurse
789243
CA
363LF0000X
Family Nurse Practitioner
Primary
AP145912
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0925166-01
TRADITIONAL MEDICAID GRP
TX
01
—
092566-02
MEDICAID EPSDT
TX
01
—
1508813494
GROUP PRACTICE NPI
TX
01
—
1730450578
INDIVIDUAL NPI
TX
01
—
988977
REGISTERED NURSE LICENSE
TX
01
—
AP145912
CERTIFIED NP LICENSE
TX
Enumeration date
01/25/2012
Last updated
09/23/2021
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