Individual
GERTHA BOUCICAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
21211 102ND AVE, APT. C4, QUEENS VILLAGE, NY 11429-1106
(718) 468-8298
Mailing address
21211 102ND AVE, APT. C4, QUEENS VILLAGE, NY 11429-1106
(718) 468-8298
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
573530
NY
363LF0000X
Family Nurse Practitioner
Primary
F345182-01
NY
Other
Enumeration date
09/22/2010
Last updated
06/30/2023
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