Healthcare Provider Details

I. General information

NPI: 1033802285
Provider Name (Legal Business Name): HAILEY ELIZABETH BOULIA-MADDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2023
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 HOSPITAL DR
YORK ME
03909-1099
US

IV. Provider business mailing address

15 PASTURE DR
HUDSON NH
03051-5138
US

V. Phone/Fax

Practice location:
  • Phone: 207-363-4321
  • Fax:
Mailing address:
  • Phone: 603-809-2212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: