Provider Demographics
NPI:1730689266
Name:BAH, ROUKIYATA
Entity type:Individual
Prefix:
First Name:ROUKIYATA
Middle Name:
Last Name:BAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3710 PORTLAND ST APT 178
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-6618
Mailing Address - Country:US
Mailing Address - Phone:614-804-1447
Mailing Address - Fax:
Practice Address - Street 1:3710 PORTLAND ST APT 178
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-6618
Practice Address - Country:US
Practice Address - Phone:614-804-1447
Practice Address - Fax:614-804-1447
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX338456164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse