Provider Demographics
NPI:1154080802
Name:AGBOMAH, SOPHIA ETOMI (CRNA)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:ETOMI
Last Name:AGBOMAH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7615 LEGACY PINES DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-2759
Mailing Address - Country:US
Mailing Address - Phone:512-704-3595
Mailing Address - Fax:
Practice Address - Street 1:MEMORIAL HERMANN
Practice Address - Street 2:27800 NORTHWEST FWY,
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433
Practice Address - Country:US
Practice Address - Phone:346-231-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX977206163W00000X
TX152950367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse