Individual
SHARON BOUSHON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
642 E PERGOLA PLACE, OAK CREEK, WI 53154
(575) 494-6850
Mailing address
642 E PERGOLA PLACE, OAK CREEK, WI 53154
(575) 494-6850
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Enumeration date
11/13/2019
Last updated
11/13/2019
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