Provider Demographics
NPI:1205815230
Name:BOULLAIN, KAREN E (RN)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:E
Last Name:BOULLAIN
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 1:2900 DELK RD SE
Mailing Address - Street 2:SUITE 700 PMB 166
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-5320
Mailing Address - Country:US
Mailing Address - Phone:678-640-7536
Mailing Address - Fax:770-492-2935
Practice Address - Street 1:2900 DELK RD SE
Practice Address - Street 2:SUITE 700 #166
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-5320
Practice Address - Country:US
Practice Address - Phone:678-640-7536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN063260163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Single Specialty