Provider Demographics
NPI:1518607662
Name:BOUSE, NATALIA V
Entity Type:Individual
Prefix:
First Name:NATALIA
Middle Name:V
Last Name:BOUSE
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:PO BOX 360091
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32936-0091
Mailing Address - Country:US
Mailing Address - Phone:321-350-1238
Mailing Address - Fax:321-622-8031
Practice Address - Street 1:2118 LITTLE JOHN RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-3736
Practice Address - Country:US
Practice Address - Phone:321-350-1238
Practice Address - Fax:321-622-8031
Is Sole Proprietor?:No
Enumeration Date:2022-03-29
Last Update Date:2022-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide