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NPI Code Detail

MEDICARE: MRS. DORIS O. BOUDREAUX R.N.

MEDICARE: MRS. DORIS O. BOUDREAUX R.N.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered NurseRN032826LA

General Provider Information

NPI Number : 1326152349
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DORIS O. BOUDREAUX R.N.
Provider Business Mailing Address
First Line : 302 DULLES DR
Second Line : SUITE 1
City : LAFAYETTE
State : LA
Zip : 70506-3008
Country : US
Telephone Number : 337-262-5870
Fax Number : 337-262-1272
Provider Business Practice Location Address
First Line : 302 DULLES DR
Second Line : SUITE 1
City : LAFAYETTE
State : LA
Zip : 70506-3008
Country : US
Telephone Number : 337-262-5870
Fax Number : 337-262-1272
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2006
Last Update Date : 07/08/2007

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