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General NPI Number Information
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NPI Number | 1912736638
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Entity Type | Individual
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Provider Name | AMINA BOUDAIA
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Gender | Female
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Dates
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Enumeration Date | 07/31/2024
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Last Update Date | 10/01/2025
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Provider Practice Location Address
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Address Line | 655 US HIGHWAY 31 S
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City | GREENWOOD
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State | IN
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Zip | 46142-3061
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Country | US
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Telephone | 866-389-2727
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 603725
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City | CHARLOTTE
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State | NC
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Zip | 28260-3725
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Country | US
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Telephone | 828-575-2625
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Fax | 828-350-2174
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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 | 71015582A
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License Number State | IN
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