Individual
MS. PATRICIA ANN BOULLIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
550 22ND ST, ASTORIA, OR 97103-3312
(503) 338-7595
(503) 325-4905
Mailing address
35242 KEE LN, ASTORIA, OR 97103-8314
(503) 325-4264
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
096007245ZN5
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
096009245ZN5
NURSING LICENSE NUMBER
OR
05
—
83621
—
OR
05
—
9618216
—
WA
Enumeration date
11/20/2006
Last updated
03/07/2023
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