Doctor Name: | NICOLE MARIE BOUWMA |
NPI Number: | 1073631552 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RN |
License Number: | |
Business Practice Address: | 1717 S 70th West Allis, WI - 53214 |
Business Phone Number: | 4147912031 |
Business Fax Number: | |
Mailing Address: | 3657 S 18th St, MILWAUKEE |
State: | WI |
Postal Code: | 532211551 |
Phone Number: | 4145174059 |
Fax Number: | |
NPI Enumeration Date: | 03/26/2007 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 163WH0200X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Nursing Service Providers |
Taxonomy Classification: | Registered Nurse |
Taxonomy Specialization: | Home Health |
Taxonomy Definition: |