Individual
WAYNE EDWARD BOULTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2716 N TENAYA WAY, LAS VEGAS, NV 89128-0424
(702) 877-8600
(702) 242-7944
Mailing address
PO BOX 35380, LAS VEGAS, NV 89133-5380
(702) 383-6210
(702) 435-7050
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
730
AK
363A00000X
Physician Assistant
Primary
PA 1456
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1528277134
—
NV
Enumeration date
05/21/2007
Last updated
12/02/2024
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