Provider Demographics
NPI:1548365984
Name:GOUDREAU, PAMELA MARIE (CRNA)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:MARIE
Last Name:GOUDREAU
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MRS
Other - First Name:PAMELA
Other - Middle Name:MARIE
Other - Last Name:BOULEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:59 PAGE HILL RD
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NH
Mailing Address - Zip Code:03570
Mailing Address - Country:US
Mailing Address - Phone:603-752-2200
Mailing Address - Fax:843-777-8705
Practice Address - Street 1:AVH 59 PAGE HILL RD
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NH
Practice Address - Zip Code:03570
Practice Address - Country:US
Practice Address - Phone:603-752-2200
Practice Address - Fax:843-777-8705
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN 3035367500000X
NH034214-23367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAN1501Medicaid
SCAN1501Medicaid