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NPI Code Detail

MEDICARE: LISA BOU C.R.N.A.

MEDICARE: LISA BOU C.R.N.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse Anesthetist453910NY

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CB1521OTHERNYRAILROAD MEDICARE GROUP
2CE9959OTHERNYRAILROAD MEDICARE GROUP
3P00119064OTHERNYRAILROAD MEDICARE
4P00290883OTHERNYRAILROAD MEDICARE

General Provider Information

NPI Number : 1437156007
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA BOU C.R.N.A.
Provider Business Mailing Address
First Line : 68 S SERVICE RD
Second Line : SUITE 350
City : MELVILLE
State : NY
Zip : 11747-2354
Country : US
Telephone Number : 516-945-3000
Fax Number :
Provider Business Practice Location Address
First Line : 45 READE PL
Second Line :
City : POUGHKEEPSIE
State : NY
Zip : 12601-3947
Country : US
Telephone Number : 845-431-5629
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2005
Last Update Date : 10/27/2009

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