Provider Demographics
NPI:1164280137
Name:BOUTON, AILEEN BRYNN (RN)
Entity Type:Individual
Prefix:MRS
First Name:AILEEN
Middle Name:BRYNN
Last Name:BOUTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1465 ROUTE 31 S STE 7
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:08801-3130
Mailing Address - Country:US
Mailing Address - Phone:908-237-2577
Mailing Address - Fax:908-894-5309
Practice Address - Street 1:1465 ROUTE 31 S STE 7
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:NJ
Practice Address - Zip Code:08801-3130
Practice Address - Country:US
Practice Address - Phone:908-237-2577
Practice Address - Fax:908-894-5309
Is Sole Proprietor?:No
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN660555163WP0808X
NJ26NR24056600163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health