Healthcare Provider Details

I. General information

NPI: 1932818259
Provider Name (Legal Business Name): ALEXIS BOUFFARD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2022
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 SAINT MICHAELS DR STE 200
SANTA FE NM
87505-8602
US

IV. Provider business mailing address

465 SAINT MICHAELS DR STE 200
SANTA FE NM
87505-8602
US

V. Phone/Fax

Practice location:
  • Phone: 303-884-4172
  • Fax:
Mailing address:
  • Phone: 303-884-4172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number61606
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: