Basic Information
| Provider Information | |||||||||
| NPI: | 1194729913 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOUDREAU | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 115 TECHNOLOGY DR | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | TRUMBULL | ||||||||
| State: | CT | ||||||||
| PostalCode: | 066116337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2034457093 | ||||||||
| FaxNumber: | 2034457094 | ||||||||
| Practice Location | |||||||||
| Address1: | 115 TECHNOLOGY DR | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | TRUMBULL | ||||||||
| State: | CT | ||||||||
| PostalCode: | 066116337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2034457093 | ||||||||
| FaxNumber: | 2034457094 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2005 | ||||||||
| LastUpdateDate: | 04/01/2015 | ||||||||
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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 | 363L00000X | 002411 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.