Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 421362 | NY |
NPI | 1013492545 |
---|---|
Provider Name | Bernice Bouzy |
First Address | East Windsor, NJ 08520-4684 |
Second Address | Patchogue, NY 11772-3145 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2018 |
Last Update Date | 01/10/2018 |