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General NPI Number Information
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NPI Number | 1891872214
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Entity Type | Individual
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Provider Name | DANA BOUDREAUX GAUTHREAUX P.A.-C
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Gender | Female
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 59213 RIVER WEST DR
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City | PLAQUEMINE
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State | LA
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Zip | 70764-6552
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Country | US
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Telephone | 225-687-2001
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Fax |
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Provider Business Mailing Address
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Address Line | 94 MASON ST
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City | GRETNA
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State | LA
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Zip | 70053-7040
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Country | US
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Telephone | 504-415-6242
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA200109
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License Number State | LA
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