Provider Demographics
NPI:1871182006
Name:BOUDREAU, PATRICIA WELCH X (RN)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:WELCH
Last Name:BOUDREAU
Suffix:X
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 PORT LAURENT PL
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7118
Mailing Address - Country:US
Mailing Address - Phone:203-779-9183
Mailing Address - Fax:
Practice Address - Street 1:1955 PORT LAURENT PL
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7118
Practice Address - Country:US
Practice Address - Phone:203-779-9183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00101163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator