Provider Demographics
NPI:1720586449
Name:BOUDREAUX, BRIDGET MARY (ADRN)
Entity Type:Individual
Prefix:MS
First Name:BRIDGET
Middle Name:MARY
Last Name:BOUDREAUX
Suffix:
Gender:F
Credentials:ADRN
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:BOUDREAUX
Other - Last Name:PHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ADRN
Mailing Address - Street 1:PO BOX 2335
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-4335
Mailing Address - Country:US
Mailing Address - Phone:406-363-9028
Mailing Address - Fax:406-363-9028
Practice Address - Street 1:116 N 9TH ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2326
Practice Address - Country:US
Practice Address - Phone:406-363-9028
Practice Address - Fax:406-363-9028
Is Sole Proprietor?:No
Enumeration Date:2018-01-28
Last Update Date:2018-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN35662163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health