Provider Demographics
NPI:1760047088
Name:BOUDREAU, ASHLEY CHRISTINE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:CHRISTINE
Last Name:BOUDREAU
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:CHRISTINE
Other - Last Name:MCINTOSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:3051 KIESEL RD
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-2449
Mailing Address - Country:US
Mailing Address - Phone:989-778-2854
Mailing Address - Fax:989-778-2887
Practice Address - Street 1:3051 KIESEL RD
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2449
Practice Address - Country:US
Practice Address - Phone:989-778-2854
Practice Address - Fax:989-778-2887
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704289275163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse