Provider Demographics
NPI:1477245447
Name:BOUTTE, LEANN
Entity Type:Individual
Prefix:MS
First Name:LEANN
Middle Name:
Last Name:BOUTTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17543 NORLENE WAY
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95949-7159
Mailing Address - Country:US
Mailing Address - Phone:530-913-6961
Mailing Address - Fax:
Practice Address - Street 1:17543 NORLENE WAY
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95949-7159
Practice Address - Country:US
Practice Address - Phone:530-913-6961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula