Individual
MRS. ELIETTE YADIRA BOUIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
GONZAGA INTERVENTIONAL PAIN MANAGEMENT, 957 NATIONAL HWY, LAVALE, MD 21502-0001
(240) 362-7128
(240) 362-7731
Mailing address
12356 WILLIAMSPORT PIKE, GREENCASTLE, PA 17225-8436
(520) 395-5881
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
Primary
C0003577
MD
363AM0700X
Medical Physician Assistant
—
—
Other
Enumeration date
02/13/2006
Last updated
11/26/2024
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