Individual
JACQUELINE ANNE BOULRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1860 TOWN CENTER DR STE 240, RESTON, VA 20190-5899
(703) 796-1986
Mailing address
1860 TOWN CENTER DR STE 240, RESTON, VA 20190-5899
(703) 796-1986
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0110009803
VA
Other
Enumeration date
03/11/2024
Last updated
02/21/2025
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