Boudreaux, Michelle Theresa

Boudreaux, Michelle Theresa is an sole proprietor health care provider with primary practice located at 202 S Park St , Madison WI 53715-1507. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Neonatal, Critical Care, Physician Assistants & Advanced Practice Nursing Providers / Pediatrics. Physician Assistants & Advanced Practice Nursing Providers / Neonatal, Critical Care is her primary health care specialty. Boudreaux, Michelle Theresa can be contacted via phone (608) 417-6236.

Contact Information

Primary practice address
202 S Park St Madison WI 53715-1507
Phone: (608) 417-6236
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Neonatal, Critical Care 363LN0005X RN047884 Louisiana
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X RN047884 Louisiana
Physician Assistants & Advanced Practice Nursing Providers / Neonatal, Critical Care 363LN0005X 21936-875 Wisconsin

Profile Details

NPI number 1861413585
LBN Legal business name Boudreaux, Michelle Theresa
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 21st, 2006
Last updated Mar 7th, 2022 - about 4 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 1861413585 NPPES
Louisiana MEDICAID 1722898

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