Individual
LISA BOU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.R.N.A.
Contact information
Practice address
45 READE PL, POUGHKEEPSIE, NY 12601-3947
(845) 431-5629
Mailing address
68 S SERVICE RD, SUITE 350, MELVILLE, NY 11747-2354
(516) 945-3000
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
453910
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CB1521
RAILROAD MEDICARE GROUP
NY
01
—
CE9959
RAILROAD MEDICARE GROUP
NY
01
—
P00119064
RAILROAD MEDICARE
NY
01
—
P00290883
RAILROAD MEDICARE
NY
Enumeration date
06/28/2005
Last updated
10/27/2009
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