| NPI | 1952185563 |
|---|---|
| Former Name | RANDI JO BOULE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WI 14170-33) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704313544) |
| Enumeration Date | 2023-08-23 |
| Last Update Date | 2025-01-22 |