Healthcare Provider Details

I. General information

NPI: 1144260852
Provider Name (Legal Business Name): ANN BOUDREAUX PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 08/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 BARKER ST COMMUNITY HEALTH AND COUNSELING SERVICES
CALAIS ME
04619-1404
US

IV. Provider business mailing address

PO BOX 425 COMMUNITY HEALTH AND COUNSELING SERVICES
BANGOR ME
04402-0425
US

V. Phone/Fax

Practice location:
  • Phone: 207-454-2743
  • Fax: 207-454-7387
Mailing address:
  • Phone: 207-947-0366
  • Fax: 207-454-7387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA-750
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: