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General NPI Number Information
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NPI Number | 1962854786
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Entity Type | Individual
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Provider Name | BRIANNA BOUTIN NP
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Gender | Female
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Dates
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Enumeration Date | 07/05/2016
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Last Update Date | 12/26/2024
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Provider Practice Location Address
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Address Line | 19 NORTHBROOK DR
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City | FALMOUTH
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State | ME
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Zip | 04105-1381
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Country | US
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Telephone | 802-523-3054
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Fax | 207-910-9620
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Provider Business Mailing Address
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Address Line | 19 NORTHBROOK DR
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City | FALMOUTH
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State | ME
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Zip | 04105-1381
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Country | US
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Telephone | 802-523-3054
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Fax | 207-910-9620
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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 | CNP161075
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License Number State | ME
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