MR. EDMUND A BOULEY (NPI# 1831286731) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1831286731 |
| Entity Type | Individual |
| Full Name | MR. EDMUND A BOULEY |
| Credential | CNS |
| Practice Address |
1420 N State St Fairmont MN 56031-3619 |
| Practice Telephone | 3202197518 |
| Mailing Telephone | 3202197518 |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2012-06-14 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163WP0808X |
Registered Nurse Specialization: Psych/Mental Health |
723743 | TX | Nursing Service Providers |
| Y | 364SP0808X |
Clinical Nurse Specialist Specialization: Psych/Mental Health |
R178506-5 | MN | Physician Assistants & Advanced Practice Nursing Providers |
| N | 364SP0808X |
Clinical Nurse Specialist Specialization: Psych/Mental Health |
723743 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | NURSING LICENSE | 723743 | 01 |
| MN | CLINICAL NURSE SPECIALIST | R178506-5 | 01 |
| Street Address |
1420 N STATE ST |
| City | FAIRMONT |
| State | MN |
| Zip Code | 56031-3619 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992803175 | Ramie Vetter | Psychologist | 1420 N State St, Fairmont, MN 56031-3619 | 2006-09-20 |
| 1164912648 | Michael Lockwood | Social Worker | 1420 N State St, Fairmont, MN 56031-3619 | 2018-05-10 |
| 1578091708 | Chelsea Teichroew | Marriage & Family Therapist | 1420 N State St, Fairmont, MN 56031-3619 | 2017-06-01 |
| 1669802088 | Heidi Schiltz | Counselor | 1420 N State St, Fairmont, MN 56031-3619 | 2013-11-21 |
| 1144535964 | Brandon Scott Dugan | Psychologist | 1420 N State St, Fairmont, MN 56031-3619 | 2010-08-17 |
| 1891961710 | Eunoia Family Resource Center Pa | Psychologist | 1420 N State St, Fairmont, MN 56031-3619 | 2008-04-30 |
| 1407051915 | Emily Kay Ovrebo | Psychologist | 1420 N State St, Fairmont, MN 56031-3619 | 2007-06-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407097025 | David Robert Rynders | Counselor | 301 Downtown Plaza, #3, Fairmont, MN 56031 | 2009-03-11 |
| 1992902449 | Wal-mart Stores, Inc. | Technician/Technologist | 1250 Goemann Road, Fairmont, MN 56031 | 2007-06-28 |
| 1417099813 | Thomas Joe Larson | Dentist | 800 Clinic Circle, Fairmont, MN 56031 | 2007-02-13 |
| 1912076795 | Rem Heartland Inc | Intermediate Care Facility, Mentally Retarded | 111 Dorothy Street, Fairmont, MN 56031 | 2006-11-07 |
| 1750466322 | Rem Heartland Inc | Intermediate Care Facility, Mentally Retarded | 107 Dorothy Street, Fairmont, MN 56031 | 2006-10-25 |
| 1588744155 | Kerri Lynn Henderson | Chiropractor | 115 1/2 West Blue Earth Ave, Fairmont, MN 56031 | 2006-10-17 |
| 1427142199 | Maurice Lee Shoen | Counselor | 115 West First St, Fairmont, MN 56031 | 2006-10-03 |
| 1538253703 | Nathan Craig Jorgenson | Dentist | 717 South State Street, Suite 600, Fairmont, MN 56031 | 2006-10-03 |
| 1942311154 | Leon James Rochovitz | Optometrist | 288 S State Street, Five Lakes Centre, Fairmont, MN 56031 | 2006-08-31 |
| 1215903414 | Mayo Clinic Hospital-rochester | Clinic/Center | 835 Johnson Street, Fairmont, MN 56031 | 2006-02-27 |
| Find all providers in zip 56031 | ||||
| Taxonomy Code | 364SP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Clinical Nurse Specialist |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730542572 | Iris Reproductive Psychiatric Clinic | Clinical Nurse Specialist | 1500 Mcandrews Road W, Ste 227, Burnsville, MN 55337 | 2016-03-30 |
| 1922159680 | Kristie Lee Sward | Clinical Nurse Specialist | 160 Kellogg Blvd E Ste 8200, Saint Paul, MN 55101-1420 | 2007-01-16 |
| 1447333513 | Karen Sue Finck | Clinical Nurse Specialist | 615 1st Ave Ne, Suite 310, Minneapolis, MN 55413-2447 | 2006-10-23 |
| 1548289259 | Judith Hilary Weis | Clinical Nurse Specialist | 27 1st St Sw, Crosby, MN 56441-1417 | 2006-07-19 |
| 1184170383 | Jessica Michelle Cadriel | Clinical Nurse Specialist | 100 Freeman Dr, Saint Peter, MN 56082-3504 | 2016-08-28 |
| 1790138550 | Katy Jean Srock | Clinical Nurse Specialist | 520 Nw 5th St, Brainerd, MN 56401-2902 | 2016-07-18 |
| 1063864395 | Sherryl St.martin | Clinical Nurse Specialist | 3101 Superior Dr Nw, Rochester, MN 55901-1993 | 2016-07-11 |
| 1386099505 | Luke Schwartz Moretti | Clinical Nurse Specialist | 2450 Riverside Ave, 6a East, Minneapolis, MN 55454-1450 | 2016-04-25 |
| 1053771428 | Psychnurse P.C. | Clinical Nurse Specialist | 3000 County Road 42 W, Suite 210, Burnsville, MN 55337-4824 | 2016-02-29 |
| 1396100046 | Jamie Lynn Giles | Clinical Nurse Specialist | 3021 Harbor Ln N, Suite 206, Plymouth, MN 55447-5109 | 2015-12-23 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.