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General NPI Number Information
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NPI Number | 1770264608
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Entity Type | Individual
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Provider Name | MARCY LEA BOUILLION APRN, FNP
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Gender | Female
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Dates
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Enumeration Date | 07/25/2023
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Last Update Date | 07/25/2023
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Provider Practice Location Address
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Address Line | 13725 FALBA RD
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City | HOUSTON
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State | TX
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Zip | 77070-3810
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Country | US
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Telephone | 281-206-0013
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Fax |
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Provider Business Mailing Address
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Address Line | 3634 COTTAGE PINES LN
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City | SPRING
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State | TX
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Zip | 77386-4500
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Country | US
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Telephone | 936-689-3151
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1127537
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License Number State | TX
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