Provider Demographics
NPI:1679671382
Name:PAUL, LUDWINE D (APRN,BC)
Entity Type:Individual
Prefix:
First Name:LUDWINE
Middle Name:D
Last Name:PAUL
Suffix:
Gender:F
Credentials:APRN,BC
Other - Prefix:
Other - First Name:LUDWINE
Other - Middle Name:D
Other - Last Name:JEAN-JACQUES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:720 HARRISON AVE DOB 503
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:732 HARRISON AVE
Practice Address - Street 2:PRESTON, 3RD FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118
Practice Address - Country:US
Practice Address - Phone:617-638-7490
Practice Address - Fax:617-414-8742
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA237745363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care