Individual
CHARLENE KAY BOUMA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
805 SUNSET BLVD, CONRAD, MT 59425-1717
(406) 271-2295
Mailing address
305 S DAKOTA ST, CONRAD, MT 59425-2414
(406) 278-7139
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
1581
MT
Other
Enumeration date
12/20/2011
Last updated
12/20/2011
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