Provider Demographics
NPI:1154628980
Name:BOUDREAU, MONIQUE (LPN)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:BOUDREAU
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 KATHRYN ST
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-7322
Mailing Address - Country:US
Mailing Address - Phone:401-636-0438
Mailing Address - Fax:
Practice Address - Street 1:1625 DIAMOND HILL RD
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-1541
Practice Address - Country:US
Practice Address - Phone:401-762-1511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI06693164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse