Active NPI
Francine Helen Boullosa, PHYSICIAN ASSISTANT
- Physician Assistant
- Salem, OR
National Provider Identifier
1275645715
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA00124
- Practice address
- 2400 Lancaster Dr NE
Salem, OR 97305-1221 - Phone
- (503) 361-5400
- Fax
- (503) 763-5972
- NPI assigned
- Aug 31, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA00124 | OR | Primary |
Addresses
Primary practice location
2400 Lancaster Dr NE
Salem, OR 97305-1221
Mailing address
2400 Lancaster Dr NE
Salem, OR 97305-1221
Phone (503) 361-5400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA00124 | OR | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1275645715",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2400 LANCASTER DR NE",
"city": "SALEM",
"state": "OR",
"postal_code": "973051221",
"telephone_number": "503-361-5400",
"fax_number": "503-763-5972"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2400 LANCASTER DR NE",
"city": "SALEM",
"state": "OR",
"postal_code": "973051221",
"telephone_number": "503-361-5400",
"fax_number": "503-763-5972"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOULLOSA",
"first_name": "FRANCINE",
"middle_name": "HELEN",
"name_prefix": "Ms.",
"credential": "PHYSICIAN ASSISTANT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "OR",
"license": "PA00124",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salem, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.