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Individual
STACY L BOURGEOIS
Active
Individual
STACY L BOURGEOIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
649012
TX
367500000X
Certified Registered Nurse Anesthetist
NA3122
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
185860701
—
TX
01
—
86993U
BLUE CROSS BLUE SHIELD
TX
01
—
P00396099
MEDICARE RAILROAD
TX
Enumeration date
01/08/2007
Last updated
06/30/2015
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