Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 074103-23 | NH |
NPI | 1013426048 |
---|---|
Provider Name | Brianna Boulanger |
First Address | Bedford, NH 03110-6764 |
Second Address | Bedford, NH 03110-6764 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2017 |
Last Update Date | 09/01/2022 |