Provider Demographics
NPI:1275630865
Name:BOUDREAUX, LINDEN (CRNA)
Entity Type:Individual
Prefix:
First Name:LINDEN
Middle Name:
Last Name:BOUDREAUX
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9050 AIRLINE HWY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-4103
Mailing Address - Country:US
Mailing Address - Phone:225-929-7210
Mailing Address - Fax:225-930-7524
Practice Address - Street 1:8212 KELWOOD AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-4801
Practice Address - Country:US
Practice Address - Phone:225-929-7600
Practice Address - Fax:225-930-7524
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA028661367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1553069Medicaid
LA59525Medicare ID - Type UnspecifiedMEDICARE IND NUMBER