Individual
MRS. MARTHA BOULTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, BC, MS, MSN
Contact information
Practice address
468 POST RD E, WESTPORT, CT 06880-4441
(203) 454-0505
(203) 454-1115
Mailing address
468 POST RD E, WESTPORT, CT 06880-4441
(203) 454-0505
(203) 454-1115
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
E35094
CT
364SP0809X
Adult Psychiatric/Mental Health Clinical Nurse Specialist
001537
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0007936120
AETNA
CT
01
—
196843
MHN
CT
01
—
2083862
CIGNA
CT
01
—
400001537CT02
ANTHEM
CT
Enumeration date
10/05/2006
Last updated
11/16/2007
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