Individual
MISS JOY IBHADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
700 SCOTT AND WHITE DR, COLLEGE STATION, TX 77845-6441
(979) 207-0100
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
078432
CT
367500000X
Certified Registered Nurse Anesthetist
Primary
AP118537
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20660601
—
TX
01
—
8529UU
BLUE CROSS BLUE SHIELD
TX
01
—
P00827795
RAILROAD MEDICARE
TX
Enumeration date
10/08/2008
Last updated
01/18/2022
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