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Individual

MRS. BOBBIE BOULWARE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
RN

Contact information

Practice address
1500 CHADFORD RD, IRMO, SC 29063-2038
(803) 476-4001
(803) 476-4020
Mailing address
1500 CHADFORD RD, IRMO, SC 29063-2038
(803) 476-4001
(803) 476-4020

Taxonomy

Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
51307
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
51307
SC
Enumeration date
05/09/2013
Last updated
05/09/2013
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