Healthcare Provider Details

I. General information

NPI: 1831706027
Provider Name (Legal Business Name): FELICIA BOULIER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FELICIA ROBERTS

II. Dates (important events)

Enumeration Date: 09/30/2020
Last Update Date: 08/25/2022
Certification Date: 08/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10800 DENNIS CHAVEZ BLVD SW
ALBUQUERQUE NM
87121-5498
US

IV. Provider business mailing address

2817 CUERVO DR NE
ALBUQUERQUE NM
87110-3103
US

V. Phone/Fax

Practice location:
  • Phone: 505-243-1458
  • Fax:
Mailing address:
  • Phone: 505-999-8973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberM-11495
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: