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General NPI Number Information
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NPI Number | 1538021068
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Entity Type | Individual
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Provider Name | JULIE BOUTHILLIER RN
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Gender | Female
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Dates
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Enumeration Date | 12/02/2025
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 1910 WASHINGTON AVE APT 114
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City | SAINT LOUIS
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State | MO
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Zip | 63103-1604
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Country | US
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Telephone | 608-780-8134
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Fax |
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Provider Business Mailing Address
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Address Line | 1910 WASHINGTON AVE APT 114
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City | SAINT LOUIS
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State | MO
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Zip | 63103-1604
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | 158025
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License Number State | IA
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