Individual
BOUVIER WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
11102 207TH ST FL 1, QUEENS VILLAGE, NY 11429-1708
(929) 899-5136
Mailing address
11102 207TH ST FL 1, QUEENS VILLAGE, NY 11429-1708
(929) 899-5136
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
713560-1
NY
363L00000X
Nurse Practitioner
Primary
F351127
NY
Other
Enumeration date
11/04/2009
Last updated
05/18/2023
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