Individual
SHANTELL BOULWARE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
272 NW MEDICAL LOOP STE E, ROSEBURG, OR 97471-5545
(541) 440-3532
Mailing address
272 NW MEDICAL LOOP STE E, ROSEBURG, OR 97471-5545
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
OR
Other
Enumeration date
01/30/2015
Last updated
01/30/2015
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