Provider Demographics
NPI:1861746661
Name:BOILEAU, ANNETTE (RN11)
Entity type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:
Last Name:BOILEAU
Suffix:
Gender:F
Credentials:RN11
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:S26W27080 MACARTHUR ROAD
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53180-5435
Mailing Address - Country:US
Mailing Address - Phone:262-650-8013
Mailing Address - Fax:
Practice Address - Street 1:260 WHITTLESEY AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-9541
Practice Address - Country:US
Practice Address - Phone:567-424-6066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-31
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI192906 - 30163W00000X
OHRN442549163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse