Provider Demographics
NPI:1427299957
Name:BOULTER, TAMELA JEAN (RN, NNP-BC)
Entity type:Individual
Prefix:MRS
First Name:TAMELA
Middle Name:JEAN
Last Name:BOULTER
Suffix:
Gender:F
Credentials:RN, NNP-BC
Other - Prefix:MRS
Other - First Name:TAMELA
Other - Middle Name:JEAN
Other - Last Name:HOURIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, NNP-BC
Mailing Address - Street 1:1480 LONE SCOUT LOOKOUT
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-8036
Mailing Address - Country:US
Mailing Address - Phone:719-481-8569
Mailing Address - Fax:
Practice Address - Street 1:1480 LONE SCOUT LOOKOUT
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-8036
Practice Address - Country:US
Practice Address - Phone:719-481-8569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-12
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO78873363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care