Most Relevant Information
Provider Data
| NPI Number: | 1003442906 |
| Provider Name: | RENELLA BOULLION APRN, FNP-BC |
| Entity Type: | Individual |
| Taxonomy Code: | 363LP0200X |
| Specialty: | Nurse Practitioner |
| License Number: | AP145643 |
Most Important Dates
| Enumeration Date: | 03/23/2020 |
| Last Updated: | 07/14/2022 |
Provider Practice Location
400 OGLETREE DR
LIVINGSTON
TX
773516783
Practice Location Phone/Fax
| Phone: | 9363288812 |
| Fax: |
Provider Mailing Location
400 OGLETREE DR
LIVINGSTON
TX
773516783
Provider Mailing Phone/Fax
| Phone: | 9363288812 |
| Fax: |