Provider Demographics
NPI:1881839330
Name:BOULE, MARIE IMMACULEE
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:IMMACULEE
Last Name:BOULE
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 1:12 MONSEY BLVD
Mailing Address - Street 2:APT.- D
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-3308
Mailing Address - Country:US
Mailing Address - Phone:845-517-0532
Mailing Address - Fax:
Practice Address - Street 1:12 MONSEY BLVD
Practice Address - Street 2:APT.- D
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-3308
Practice Address - Country:US
Practice Address - Phone:845-517-0532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY282092-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse