Provider Demographics
NPI:1740573682
Name:BOUDREAUX, LAURA RHEA (MPH, RD, LD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:RHEA
Last Name:BOUDREAUX
Suffix:
Gender:F
Credentials:MPH, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14023 SOUTHWEST FWY
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3550
Mailing Address - Country:US
Mailing Address - Phone:281-325-4256
Mailing Address - Fax:281-325-4268
Practice Address - Street 1:14023 SOUTHWEST FWY
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3550
Practice Address - Country:US
Practice Address - Phone:281-325-4256
Practice Address - Fax:281-325-4268
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT81271133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered