IndividualActive
Mario Bouchard
NPI 1104350859 · Critical Care Medicine Registered Nurse · Gallup, NM
Provider details
- NPI number
- 1104350859
- Entity type
- Individual
- Primary specialty
- Critical Care Medicine Registered NurseNursing Service Providers
- Sex
- Male
- Sole proprietor
- No
- License
- RN 3173492 (FL)
Specialties & taxonomies
Nursing Service Providers
Practice location
516 E Nizhoni Blvd
Gallup, NM 87301-5748
Phone: (505) 722-1000
Approximate (ZIP-level) locationGet directions
Mailing address
516 E Nizhoni Blvd
Gallup, NM 87301-5748
Registry dates
- Enumerated
- 2017-04-19
- Last updated
- 2017-04-19
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.