Provider Demographics
NPI:1346594330
Name:BOUZI, ROSELINE
Entity Type:Individual
Prefix:MRS
First Name:ROSELINE
Middle Name:
Last Name:BOUZI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 MIDDLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-4513
Mailing Address - Country:US
Mailing Address - Phone:631-921-1174
Mailing Address - Fax:
Practice Address - Street 1:41 MIDDLE DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-4513
Practice Address - Country:US
Practice Address - Phone:631-921-1174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY284505-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse