-- MARIO BOUCHARD --
Individual Provider (NPI-1)
Active
Registered Nurse, Critical Care Medicine
Provider Information
- NPI Number
1104350859- Provider Type
- Individual Provider (NPI-1)
- Status
- Active
Contact & Location
- Address
- 516 E NIZHONI BLVD, GALLUP, NM, 873015748
- Phone
- (505) 722-1000
Specialties & Taxonomies
Registered Nurse, Critical Care Medicine
Primary License: FL #RN 3173492
All Addresses
MAILING
516 E NIZHONI BLVD
GALLUP, NM, 873015748