Jenna Boutilier, NP
Individual provider Active NPI Nurse Practitioner · Cumberland, RI
NPI 1154657443 · NPPES record last updated Oct 22, 2009
Key facts
- NPI
- 1154657443
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- NPP37529 (RI)
- Practice address
- 106 Nate Whipple Hwy
Suite 101
Cumberland, RI 02864-1403 - Phone
- (401) 658-2020
- Fax
- (401) 658-3612
- NPI assigned
- Oct 22, 2009
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NPP37529 | RI | MD | Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | NPP37529 | RI | Yes |
Addresses
Primary practice location
106 Nate Whipple Hwy
Suite 101
Cumberland, RI 02864-1403
Mailing address
PO Box 27
Manville, RI 02838-0027
Phone (800) 927-0002
Other providers in Cumberland, RI
- Karen A Bouchard
- Matthew Boucher
- Nompelelo Khumalo Boucher
- Robert Bouffard
- Guy M Boulay
- Kerianne Brady
- James J. Brennan
- Brookside Medical Associates, P.C.
- Brown Vision Care, Inc
- Meaghan Bruneault
All providers in Cumberland, RI · Nurse Practitioner in Rhode Island
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 22, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.