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General NPI Number Information
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NPI Number | 1093593931
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Entity Type | Individual
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Provider Name | GABRIELLE BOUDREAU MSN, WHNP
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Gender | Female
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Dates
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Enumeration Date | 09/21/2023
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Last Update Date | 11/06/2023
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Provider Practice Location Address
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Address Line | 506 6TH ST
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City | BROOKLYN
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State | NY
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Zip | 11215-3609
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Country | US
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Telephone | 860-384-5142
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Fax |
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Provider Business Mailing Address
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Address Line | 110 LIVINGSTON ST APT 10M
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City | BROOKLYN
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State | NY
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Zip | 11201-5063
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Country | US
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Telephone | 860-384-5142
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Fax |
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | F421657
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License Number State | NY
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