Individual
JODY A BOUMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
1113 ALTA AVE STE 220, UPLAND, CA 91786-2803
(909) 985-1908
(909) 985-5583
Mailing address
1113 ALTA AVE STE 220, UPLAND, CA 91786-2803
(909) 985-1908
(909) 985-5583
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
17316
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17316
NURSE PRACTITIONER LIC
CA
Enumeration date
05/29/2009
Last updated
05/29/2009
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