Individual
CIERRA JEAN BOUTELLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4391 SODA CREEK RD APT 4, OSHKOSH, WI 54901-1149
(608) 290-3418
Mailing address
4391 SODA CREEK RD APT 4, OSHKOSH, WI 54901-1149
(608) 290-3418
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
01/16/2023
Last updated
01/16/2023
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