Marilyn Waugh Bouldin
Individual provider Active NPI Registered Nurse · Salida, CO
NPI 1952573859 · NPPES record last updated Mar 31, 2008
Key facts
- NPI
- 1952573859
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 39316 (CO)
- Practice address
- 209 E 3Rd St
Salida, CO 81201-2614 - Phone
- (719) 539-4510
- Fax
- (719) 539-7197
- NPI assigned
- Mar 31, 2008
- 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)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 39316 | CO | MD | Internal Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 39316 | CO | Yes |
Addresses
Primary practice location
209 E 3Rd St
Salida, CO 81201-2614
Mailing address
209 E 3Rd St
Salida, CO 81201-2614
Phone (719) 539-4510
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 04419099 | Medicaid | CO |
Other providers in Salida, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 31, 2008. 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.