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1003235706 NPI number — LAUREN ELIZABETH BOUDREAUX DO

NPI Number: 1003235706
Health Care Provider/Practitioner: LAUREN ELIZABETH BOUDREAUX DO

Information about “1003235706” NPI (LAUREN ELIZABETH BOUDREAUX DO) exists in 1003235706 in HTML format HTML  |  1003235706 in plain Text format TXT  |  1003235706 in PDF (Portable Document Format) PDF  |  1003235706 in an XML format XML  formats.

NPI Number : 1003235706 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1003235706",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BOUDREAUX",
    "FirstName": "LAUREN",
    "MiddleName": "ELIZABETH",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "DO",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "RIEDMUELLER",
    "OtherFirstName": "LAUREN",
    "OtherMiddleName": "ELIZABETH",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "1793 13TH ST SE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SALEM",
    "MailingAddressStateName": "OR",
    "MailingAddressPostalCode": "97302-2541",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "33-628-3855",
    "MailingAddressFaxNumber": "503-362-8435",
    "FirstLinePracticeLocationAddress": "2415 NE 134TH ST STE 107",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "VANCOUVER",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98686-3031",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "360-576-3340",
    "PracticeLocationAddressFaxNumber": "503-362-8435",
    "EnumerationDate": "04/09/2014",
    "LastUpdateDate": "10/10/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207N00000X",
        "TaxonomyName": "Dermatology Physician",
        "LicenseNumber": "OP60565798",
        "LicenseNumberStateCode": "WA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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