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Jimi Leah Boulet

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

9900 Bren Rd E, Minnetonka, MN 55343-9664

PECOS Enrollment

Based on the most recent information from CMS, provider Jimi Leah Boulet does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 4 days ago.

Profile Details

Provider ID
1902108376
Provider Type
Individual
Full Name
Boulet, Jimi Leah
Title
Mrs.
Credential
NP

Gender
Female
Sole Proprietor
Yes
Enumeration Date
11/17/2010
Last Updated
9/25/2020

Contact Information

Practice Location

9900 Bren Rd E, Minnetonka, MN 55343-9664

(608) 332-6905

Unlisted Fax

Mailing Location

1712a California Ave SW, Seattle, WA 98116-1903

(608) 332-6905

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363L00000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 60616114-NP Washington
Code 163W00000X	Description Registered Nurse Nursing Service Providers	License 169703-030 Wisconsin
Code 163W00000X	Description Registered Nurse Nursing Service Providers	License 60404379-RN Washington
Code 363L00000X	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 5396-33 Wisconsin
Code 363LA2200X	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 5396-33 Wisconsin
Code 363LA2200X	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 60616114-NP Washington
Code 363LG0600X	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 5396-33 Wisconsin
Code 363LG0600X	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 60616114-NP Washington

Jimi Leah Boulet

PECOS Enrollment

Profile Details

Contact Information

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