Individual
MRS. LISA BOULE'
Active
Individual
MRS. LISA BOULE'
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
0024165610
VA
363LP0200X
Pediatric Nurse Practitioner
358860-1
NY
363LP0200X
Pediatric Nurse Practitioner
Primary
F381165-1
NY
Other
Enumeration date
06/14/2007
Last updated
08/03/2010
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