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General NPI Number Information
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NPI Number | 1689075509
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Entity Type | Individual
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Provider Name | BORIS BOGUSLAVSKIY NP
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Gender | Male
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Dates
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Enumeration Date | 09/10/2014
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Last Update Date | 02/23/2022
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Provider Practice Location Address
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Address Line | 5656 S POWER RD STE 132
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City | GILBERT
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State | AZ
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Zip | 85295-8490
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Country | US
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Telephone | 917-691-3131
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Fax |
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Provider Business Mailing Address
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Address Line | 5656 S POWER RD STE 132
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City | GILBERT
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State | AZ
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Zip | 85295-8490
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Country | US
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Telephone | 917-691-3131
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 306933
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License Number State | NY
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