Healthcare Provider Details

I. General information

NPI: 1720586449
Provider Name (Legal Business Name): BRIDGET MARY BOUDREAUX ADRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRIDGET BOUDREAUX PHAM ADRN

II. Dates (important events)

Enumeration Date: 01/28/2018
Last Update Date: 01/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 N 9TH ST
HAMILTON MT
59840-2326
US

IV. Provider business mailing address

PO BOX 2335
HAMILTON MT
59840-4335
US

V. Phone/Fax

Practice location:
  • Phone: 406-363-9028
  • Fax: 406-363-9028
Mailing address:
  • Phone: 406-363-9028
  • Fax: 406-363-9028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN35662
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: