Individual
HOLLY SUSAN BOUTWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
2105 E SOUTH BLVD, MONTGOMERY, AL 36116-2409
(334) 286-2823
Mailing address
1535 COUNTY ROAD 37, FITZPATRICK, AL 36029-2909
(214) 995-7979
Taxonomy
Speciality
Code
Description
License number
State
163WN0002X
Neonatal Intensive Care Registered Nurse
Primary
1-156485
AL
Other
Enumeration date
01/09/2019
Last updated
01/09/2019
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