Individual
MISTY BOUDREAUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
180 W ESPLANADE AVE, KENNER, LA 70065-2467
(504) 468-8600
Mailing address
6875 WEST END BLVD, NEW ORLEANS, LA 70124
(504) 655-1012
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
AP07975
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07984823
—
MS
05
—
2373234
—
LA
Enumeration date
08/19/2014
Last updated
11/18/2014
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