NPI | 1689121881 |
---|---|
Former Name | ANDREA BOULDIN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 163W00000X Registered Nurse (Licence: OH 422140) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0029137) |
Enumeration Date | 2016-09-06 |
Last Update Date | 2022-03-16 |