Provider Demographics
NPI:1891861688
Name:BOUDREAU, JANICE H (CERTIFIED PEDORTHIST)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:H
Last Name:BOUDREAU
Suffix:
Gender:F
Credentials:CERTIFIED PEDORTHIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03246-3448
Mailing Address - Country:US
Mailing Address - Phone:603-528-1528
Mailing Address - Fax:603-528-1528
Practice Address - Street 1:612 MAIN ST
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-3448
Practice Address - Country:US
Practice Address - Phone:603-528-1528
Practice Address - Fax:603-528-1528
Is Sole Proprietor?:No
Enumeration Date:2006-11-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist