Provider Demographics
NPI:1871195859
Name:BOGHOSSIAN, NAIRY SKENDER
Entity Type:Individual
Prefix:
First Name:NAIRY
Middle Name:SKENDER
Last Name:BOGHOSSIAN
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 1:7051 W CHOLLA ST
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-5866
Mailing Address - Country:US
Mailing Address - Phone:623-412-4675
Mailing Address - Fax:623-412-4685
Practice Address - Street 1:7051 W CHOLLA ST
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-5866
Practice Address - Country:US
Practice Address - Phone:623-412-4675
Practice Address - Fax:623-412-4685
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP051543164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse