Provider Demographics
NPI:1992465322
Name:BOUMA, CHRISTINE L (BSN)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:L
Last Name:BOUMA
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17132 SAINT ANDREWS LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-4548
Mailing Address - Country:US
Mailing Address - Phone:714-803-5499
Mailing Address - Fax:
Practice Address - Street 1:1091 N BATAVIA ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-5548
Practice Address - Country:US
Practice Address - Phone:949-273-0555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-27
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95038992163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse