Healthcare Provider Details

I. General information

NPI: 1669318952
Provider Name (Legal Business Name): EUGENE W BOUDREAU RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 LEON RD
BRISTOL CT
06010-6903
US

IV. Provider business mailing address

25 LEON RD
BRISTOL CT
06010-6903
US

V. Phone/Fax

Practice location:
  • Phone: 860-558-2627
  • Fax:
Mailing address:
  • Phone: 860-558-2627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberR27856
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: