Individual
BERNADETTE BOUCIQUOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6333 E SKELLY DR, TULSA, OK 74135-6106
(918) 664-4224
Mailing address
6333 E SKELLY DR, TULSA, OK 74135-6106
(918) 664-4224
Taxonomy
Speciality
Code
Description
License number
State
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
Primary
9416618
FL
Other
Enumeration date
06/30/2020
Last updated
06/30/2020
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