Individual provider · Type 1 NPI
Jacqueline Anne Boulris, PA-C
Medical Physician Assistant · Reston, VA
NPI number
1639937154
Active
Practice location
1860 Town Center Dr Ste 240
Reston, VA 20190-5899
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Medical Physician Assistant Primary | 363AM0700X | 0110009803 (VA) |
Medical Physician Assistant: Definition to come...
3 other providers at this address
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- Larry C. Mack-Wilson, P.A.Medical Physician Assistant Reston, VA NPI 1235413667
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About NPI 1639937154
Jacqueline Anne Boulris, PA-C's National Provider Identifier is 1639937154, issued on Mar 11, 2024. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Reston, VA. The record was last updated on Feb 21, 2025.