Provider Demographics
NPI:1003647439
Name:BOIVIN, JULIE MARIE (RN)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:MARIE
Last Name:BOIVIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4491 WAL VALLEY WAY # A
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-7373
Mailing Address - Country:US
Mailing Address - Phone:270-535-2047
Mailing Address - Fax:
Practice Address - Street 1:4491 WAL VALLEY WAY
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-7373
Practice Address - Country:US
Practice Address - Phone:270-535-2047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1101146163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)Group - Single Specialty