Basic Information
| Provider Information | |||||||||
| NPI: | 1730414913 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOUTWELL | ||||||||
| FirstName: | JOAN | ||||||||
| MiddleName: | |||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 172 KINSLEY ST | ||||||||
| Address2: | |||||||||
| City: | NASHUA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030603648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038823000 | ||||||||
| FaxNumber: | 6035785023 | ||||||||
| Practice Location | |||||||||
| Address1: | 172 KINSLEY ST | ||||||||
| Address2: | |||||||||
| City: | NASHUA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030603648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038823000 | ||||||||
| FaxNumber: | 6035785023 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2009 | ||||||||
| LastUpdateDate: | 01/22/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 024640-23 | NH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.