Provider Demographics
NPI:1831374578
Name:BOUFFARD, JULIANN MICHELLE (RN)
Entity type:Individual
Prefix:MS
First Name:JULIANN
Middle Name:MICHELLE
Last Name:BOUFFARD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7975 MAPLEDALE RD
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-3750
Mailing Address - Country:US
Mailing Address - Phone:440-255-0517
Mailing Address - Fax:
Practice Address - Street 1:7196 GRANT ST
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4702
Practice Address - Country:US
Practice Address - Phone:440-942-1914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.222528163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse