Provider Demographics
NPI:1619136280
Name:BOULANGER, NATASHA ALEXANDRIA (LMP, LE)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:ALEXANDRIA
Last Name:BOULANGER
Suffix:
Gender:F
Credentials:LMP, LE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7529 BEVERLY BLVD
Mailing Address - Street 2:BOX 3
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-6770
Mailing Address - Country:US
Mailing Address - Phone:425-923-4934
Mailing Address - Fax:
Practice Address - Street 1:7529 BEVERLY BLVD
Practice Address - Street 2:BOX 3
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-6770
Practice Address - Country:US
Practice Address - Phone:425-923-4934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-08
Last Update Date:2008-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA20642172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker