Individual provider · NPI-1

Boris G Kouanang, CRNA

Nurse Anesthetist, Certified Registered · Livingston, NJ

NPI number1154086643

StatusActive

Last updated in NPPESNov 1, 2021

Details

NPI: 1154086643
Entity type: Individual (NPI-1)
Name: Boris G Kouanang
Credential: CRNA
Sex: Male
Sole proprietor: No
Enumeration date: Nov 1, 2021
Certification date: Aug 12, 2021
Last updated: Nov 1, 2021

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
367500000X	Nurse Anesthetist, Certified Registered	26NJ01224000	NJ	Yes

Practice location

94 Old Short Hills Rd Ste 1
Livingston, NJ 07039-5668

Phone 973-322-5000

Mailing address

200 Boyden Ave Apt 374
Maplewood, NJ 07040-2685

Phone 609-218-7884

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