Individual
MR. EDMUND A BOULEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CNS
Contact information
Practice address
1420 N STATE ST, FAIRMONT, MN 56031-3619
(320) 219-7518
Mailing address
1420 N STATE ST, FAIRMONT, MN 56031-3619
(320) 219-7518
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
723743
TX
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
723743
TX
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
Primary
R178506-5
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
723743
NURSING LICENSE
TX
01
—
R178506-5
CLINICAL NURSE SPECIALIST
MN
Enumeration date
10/10/2006
Last updated
06/14/2012
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