Basic Information
| Provider Information | |||||||||
| NPI: | 1376560144 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOUDREAUX | ||||||||
| FirstName: | DONNA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1725 | ||||||||
| Address2: | |||||||||
| City: | GONZALES | ||||||||
| State: | LA | ||||||||
| PostalCode: | 707071725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2256215770 | ||||||||
| FaxNumber: | 2256443208 | ||||||||
| Practice Location | |||||||||
| Address1: | 1112 E ASCENSION COMPLEX BLVD | ||||||||
| Address2: | |||||||||
| City: | GONZALES | ||||||||
| State: | LA | ||||||||
| PostalCode: | 707374265 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2256215770 | ||||||||
| FaxNumber: | 2256443208 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 163W00000X | RNO49698 | LA | Y | Nursing Service Providers | Registered Nurse |
No ID Information.