Provider Demographics
NPI:1508495805
Name:BOUAROY, SOUAY
Entity Type:Individual
Prefix:
First Name:SOUAY
Middle Name:
Last Name:BOUAROY
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 1:2831 CONRAD DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-3597
Mailing Address - Country:US
Mailing Address - Phone:614-753-7108
Mailing Address - Fax:
Practice Address - Street 1:2831 CONRAD DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-3597
Practice Address - Country:US
Practice Address - Phone:614-753-7108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty