Doctor Name: | MRS. TAMELA JEAN BOULTER |
NPI Number: | 1427299957 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RN, NNP-BC |
License Number: | 78873 |
Business Practice Address: | 1480 Lone Scout Lookout Monument, CO - 801328036 |
Business Phone Number: | 7194818569 |
Business Fax Number: | |
Mailing Address: | 1480 Lone Scout Lookout, MONUMENT |
State: | CO |
Postal Code: | 801328036 |
Phone Number: | 7194818569 |
Fax Number: | |
NPI Enumeration Date: | 03/12/2009 |
NPI Last Update Date: | 03/12/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LN0005X |
License Number: | 78873 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CO |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Neonatal, Critical Care |
Taxonomy Definition: |