Provider Demographics
NPI:1073922464
Name:SMITH-BOUTIN, ASHLEY AREN (NP, RN)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:AREN
Last Name:SMITH-BOUTIN
Suffix:
Gender:F
Credentials:NP, RN
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:100 BOSTON RD
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:MA
Mailing Address - Zip Code:01450-1879
Mailing Address - Country:US
Mailing Address - Phone:978-448-4300
Mailing Address - Fax:978-448-4040
Practice Address - Street 1:100 BOSTON RD
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:MA
Practice Address - Zip Code:01450-1879
Practice Address - Country:US
Practice Address - Phone:978-448-4300
Practice Address - Fax:978-448-4040
Is Sole Proprietor?:No
Enumeration Date:2014-08-11
Last Update Date:2016-08-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MARN2284089163W00000X, 363LP2300X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health