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NPI Code Detail

MEDICARE: MICHELLE C BOUDRIA NP

MEDICARE: MICHELLE C BOUDRIA NP
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
1363LA2100XAcute Care Nurse Practitioner636309TX
2363L00000XNurse PractitionerAP115310TX

General Provider Information

NPI Number : 1578641445
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE C BOUDRIA NP
Provider Business Mailing Address
First Line : 1902 WINDSOR PL STE 102
Second Line :
City : FORT WORTH
State : TX
Zip : 76110-1866
Country : US
Telephone Number : 682-207-1700
Fax Number : 682-250-5246
Provider Business Practice Location Address
First Line : 1902 WINDSOR PL STE 102
Second Line :
City : FORT WORTH
State : TX
Zip : 76110-1866
Country : US
Telephone Number : 682-207-1700
Fax Number : 682-250-5246
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2006
Last Update Date : 03/31/2021

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Directions to “ MICHELLE C BOUDRIA NP” Practice Location

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