Individual
KIM MARIE BOULTINGHOUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
94-1141 AKEU PL, WAIPAHU, HI 96797-4039
(503) 703-8191
Mailing address
94-1141 AKEU PL, WAIPAHU, HI 96797-4039
(503) 703-8191
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
72108
HI
163WS0200X
School Registered Nurse
Primary
72108
HI
Other
Enumeration date
04/17/2019
Last updated
04/17/2019
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