Provider Demographics
NPI:1891512638
Name:BOBOYE, BUKOLA PONMILE
Entity type:Individual
Prefix:
First Name:BUKOLA
Middle Name:PONMILE
Last Name:BOBOYE
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 1:316 WALLACE CT
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-6861
Mailing Address - Country:US
Mailing Address - Phone:573-268-0217
Mailing Address - Fax:
Practice Address - Street 1:316 WALLACE CT
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-6861
Practice Address - Country:US
Practice Address - Phone:636-634-0479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR2110910251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health