Provider Demographics
NPI:1902012966
Name:CHASE-BOUAMOUD, NINA C (PA-C)
Entity type:Individual
Prefix:MRS
First Name:NINA
Middle Name:C
Last Name:CHASE-BOUAMOUD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NINA
Other - Middle Name:
Other - Last Name:CHASE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2767 SILVER CREEK RD STE A
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-8227
Mailing Address - Country:US
Mailing Address - Phone:928-704-6741
Mailing Address - Fax:
Practice Address - Street 1:2767 SILVER CREEK RD
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-8227
Practice Address - Country:US
Practice Address - Phone:928-704-6741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5781363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5781OtherSTATE