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General NPI Number Information
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NPI Number | 1003235706
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Entity Type | Individual
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Provider Name | LAUREN ELIZABETH BOUDREAUX DO
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Gender | Female
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Dates
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Enumeration Date | 04/09/2014
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Last Update Date | 10/10/2024
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Provider Practice Location Address
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Address Line | 2415 NE 134TH ST STE 107
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City | VANCOUVER
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State | WA
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Zip | 98686-3031
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Country | US
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Telephone | 360-576-3340
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Fax | 503-362-8435
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Provider Business Mailing Address
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Address Line | 1793 13TH ST SE
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City | SALEM
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State | OR
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Zip | 97302-2541
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Country | US
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Telephone | 33-628-3855
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Fax | 503-362-8435
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | OP60565798
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License Number State | WA
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