Healthcare Provider Details

I. General information

NPI: 1609686351
Provider Name (Legal Business Name): BOUGIE CRNA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13760 N 93RD AVE STE 101
PEORIA AZ
85381-4203
US

IV. Provider business mailing address

PO BOX 41150
MESA AZ
85274-1150
US

V. Phone/Fax

Practice location:
  • Phone: 623-547-2600
  • Fax:
Mailing address:
  • Phone: 480-425-2160
  • Fax: 480-839-4727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: GWLADYS DOROTHEE EMAZE BEST
Title or Position: OWNER
Credential: CRNA
Phone: 202-557-6453