Provider Demographics
NPI:1144260852
Name:BOUDREAUX, ANN (PA)
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:
Last Name:BOUDREAUX
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 425
Mailing Address - Street 2:COMMUNITY HEALTH AND COUNSELING SERVICES
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-0425
Mailing Address - Country:US
Mailing Address - Phone:207-947-0366
Mailing Address - Fax:207-454-7387
Practice Address - Street 1:10 BARKER ST
Practice Address - Street 2:COMMUNITY HEALTH AND COUNSELING SERVICES
Practice Address - City:CALAIS
Practice Address - State:ME
Practice Address - Zip Code:04619-1404
Practice Address - Country:US
Practice Address - Phone:207-454-2743
Practice Address - Fax:207-454-7387
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA-750363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEP48772Medicare UPIN
AP1607Medicare ID - Type Unspecified