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Individual

NILDA C GOMEZ-BOUFFARD

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CRNA

Contact information

Practice address
23901 LAHSER RD, SOUTHFIELD, MI 48034-6035
(248) 357-3360
(248) 357-0915
Mailing address
6336 BEECH DALY, DEARBORN HEIGHTS, MI 48127-3066
(313) 565-8517
(248) 357-0915

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704082875
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
NB082875
BCBSM NUMBER
MA
Enumeration date
06/13/2006
Last updated
09/26/2007
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