Individual
CHANEL BOVIAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
587 BROADWAY APT.A2, MENANDS, NY 12204
(347) 262-1929
Mailing address
587 BROADWAY APT.A2, MENANDS, NY 12204
(347) 262-1929
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
318141
NY
Other
Enumeration date
07/20/2019
Last updated
07/20/2019
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