Provider Demographics
NPI:1164793659
Name:BOURDEAU, LAUREN
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:BOURDEAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:BLANCHETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP, RN-BC
Mailing Address - Street 1:20 WEST ST
Mailing Address - Street 2:
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-1920
Mailing Address - Country:US
Mailing Address - Phone:845-405-3080
Mailing Address - Fax:
Practice Address - Street 1:20 WEST ST
Practice Address - Street 2:
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-1920
Practice Address - Country:US
Practice Address - Phone:845-405-3080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-16
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY649745163W00000X
NY689033163WX0200X
NY356166363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No163WX0200XNursing Service ProvidersRegistered NurseOncology