Bruce Bouchard
Individual provider Active NPI Registered Nurse · Gallup, NM
NPI 1366626152 · NPPES record last updated Dec 28, 2007
Key facts
- NPI
- 1366626152
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- R46704 (NM)
- Practice address
- 516 Nizhoni Blvd
Gallup, NM 87301-5748 - Phone
- (505) 722-1000
- Fax
- (505) 722-1310
- NPI assigned
- Dec 28, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R46704 | NM | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | R46704 | NM | Yes |
Addresses
Primary practice location
516 Nizhoni Blvd
Gallup, NM 87301-5748
Mailing address
PO Box 1337
Gallup, NM 87305-1337
Phone (505) 722-1000
Other providers in Gallup, NM
- Rebecca Lynn Boone
- Lorelia Booqua-Pooacha
- Corrie Booqua
- Dianne Bordas
- Loretta Sue Boshart
- Mario Bouchard
- Althea Bowekaty
- Tiffany Bowen-Olney
- Pamela Kathleen Bowers
- Nicole Bowsley
All providers in Gallup, NM · Registered Nurse in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 28, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.