Provider Demographics
NPI:1275568305
Name:BOUDREAU, NICOLE HURLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:HURLEY
Last Name:BOUDREAU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1180 BEACON STREET
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446
Mailing Address - Country:US
Mailing Address - Phone:617-232-0440
Mailing Address - Fax:617-232-8444
Practice Address - Street 1:1180 BEACON STREET
Practice Address - Street 2:SUITE 2C
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446
Practice Address - Country:US
Practice Address - Phone:617-232-0440
Practice Address - Fax:617-232-8444
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2013-09-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA205483207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0108197Medicaid
H020273Medicare UPIN
MA0108197Medicaid