Boutwell, Jacque Arlin

Boutwell, Jacque Arlin is an individual health care provider with primary practice located at 3301 County Rd 6 E , Elkhart IN 46514-7673. He recently has 2 registered licenses in different health care specialties including Technologists, Technicians & Other Technical Service Providers / Surgical Technologist, Technologists, Technicians & Other Technical Service Providers / Surgical Assistant. Technologists, Technicians & Other Technical Service Providers / Surgical Assistant is his primary health care specialty. Boutwell, Jacque Arlin can be contacted via phone (574) 214-7504.

Contact Information

Primary practice address
3301 County Rd 6 E Elkhart IN 46514-7673
Phone: (574) 214-7504
Fax: (574) 262-3214
Website:
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Health care specialties

SpecialtyCodeLicense #State
Technologists, Technicians & Other Technical Service Providers / Surgical Technologist 246ZS0410X
Technologists, Technicians & Other Technical Service Providers / Surgical Assistant 246ZC0007X

Profile Details

NPI number 1013062405
LBN Legal business name Boutwell, Jacque Arlin
Credentials CFA
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 24th, 2007
Last updated Nov 25th, 2014 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1013062405 NPPES
Indiana Other 000000577411 ANTHEM BCBS

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