Provider Demographics
NPI:1720323843
Name:BOUDREAUX, ROSEMARY
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:
Last Name:BOUDREAUX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROSEMARY
Other - Middle Name:ATKINSON
Other - Last Name:BOUDREAUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, IBCLC
Mailing Address - Street 1:9549 E 57TH TER
Mailing Address - Street 2:
Mailing Address - City:RAYTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:64133-3395
Mailing Address - Country:US
Mailing Address - Phone:816-678-7825
Mailing Address - Fax:816-353-2617
Practice Address - Street 1:9549 E 57TH TER
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64133-3395
Practice Address - Country:US
Practice Address - Phone:816-678-7825
Practice Address - Fax:816-353-2617
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO163WL0100X163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant