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Individual

MRS. ANITA BOULOM

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
3400 DEERFIELD DR, JANESVILLE, WI 53546-3557
(608) 314-3600
Mailing address
700 UNIVERSITY BAY DR APT 315, MADISON, WI 53705-2268
(469) 348-5497

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5192-23
WI

Other

Enumeration date
01/11/2021
Last updated
01/11/2021
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