Individual
MR. JUSTIN BOUTWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
145 MEMORIAL DR, BROKEN BOW, NE 68822-1378
(308) 872-2486
(308) 872-2027
Mailing address
145 MEMORIAL DR, BROKEN BOW, NE 68822-1378
(308) 991-4571
(308) 872-2027
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
2387
NE
Other
Enumeration date
02/25/2019
Last updated
08/19/2019
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