Boudoin, Stacey W.

Boudoin, Stacey W. is an sole proprietor health care provider with primary practice located at 635 Lafitte St Ste B , Mandeville LA 70448-5269. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health, which is considered as her primary health care specialty. Boudoin, Stacey W. can be contacted via phone (985) 624-5305.

Contact Information

Primary practice address
635 Lafitte St Ste B Mandeville LA 70448-5269
Phone: (985) 624-5305
Fax: (985) 624-8643
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X RN072251 Louisiana

Profile Details

NPI number 1861459794
LBN Legal business name Boudoin, Stacey W.
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 26th, 2006
Last updated Mar 17th, 2018 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1861459794 NPPES
Louisiana MEDICAID 1468584
Louisiana MEDICAID 04002873

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