Provider Demographics
NPI:1720184203
Name:LEBOURDAIS, AUDREY S (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:S
Last Name:LEBOURDAIS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:AUDREY
Other - Middle Name:S
Other - Last Name:GIULIANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:23 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NH
Mailing Address - Zip Code:03051-5207
Mailing Address - Country:US
Mailing Address - Phone:603-594-9818
Mailing Address - Fax:603-303-3098
Practice Address - Street 1:41 MALL RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01805-0001
Practice Address - Country:US
Practice Address - Phone:781-744-8132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA168258367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP00118377OtherRAILROAD MEDICARE
MANA1031Medicare PIN