Individual
RENELLA BOULLION
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN, FNP-BC
Contact information
Practice address
400 OGLETREE DR, LIVINGSTON, TX 77351-6783
(936) 328-8812
Mailing address
400 OGLETREE DR, LIVINGSTON, TX 77351-6783
(936) 328-8812
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
AP145643
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AP145643
PRIVATE INSURANCE
TX
05
—
AP145643
—
TX
Enumeration date
03/23/2020
Last updated
07/14/2022
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