Basic Information
| Provider Information | |||||||||
| NPI: | 1154628980 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOUDREAU | ||||||||
| FirstName: | MONIQUE | ||||||||
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| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 KATHRYN ST | ||||||||
| Address2: | |||||||||
| City: | CUMBERLAND | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028647322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4016360438 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1625 DIAMOND HILL RD | ||||||||
| Address2: | |||||||||
| City: | WOONSOCKET | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028951541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017621511 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2011 | ||||||||
| LastUpdateDate: | 02/14/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 06693 | RI | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.