Provider Demographics
NPI:1578705422
Name:BOULANGER, CHRISTOPHER ROY (LPN)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:ROY
Last Name:BOULANGER
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 SANFORD LN
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:CT
Mailing Address - Zip Code:06751-1816
Mailing Address - Country:US
Mailing Address - Phone:203-980-1421
Mailing Address - Fax:
Practice Address - Street 1:33 SANFORD LN
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:CT
Practice Address - Zip Code:06751-1816
Practice Address - Country:US
Practice Address - Phone:203-980-1421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY293066-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse