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1184213555
ANITA BOULOM
JANESVILLE, WI
NPI
1184213555
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: WI 5192-23)
Enumeration Date
2021-01-11
Last Update Date
2021-01-11
Business Address
MRS. ANITA BOULOM PA-C
3400 DEERFIELD DR
JANESVILLE, WI 53546-3557
Phone number: 608-314-3600
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Mailing Address
MRS. ANITA BOULOM PA-C
700 UNIVERSITY BAY DR APT 315
MADISON, WI 53705-2268
Phone number: 469-348-5497
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