Individual
KELLIEANNE T BOUTILIER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
127 PLYMPTON ST, MIDDLEBORO, MA 02346-2609
(508) 946-6906
Mailing address
127 PLYMPTON ST, MIDDLEBORO, MA 02346-2609
(508) 946-6906
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
274450
MA
163W00000X
Registered Nurse
RN44317
RI
Other
Enumeration date
06/29/2007
Last updated
07/08/2007
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