Individual
AMY BOUDONCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1406 N 39TH ST, EAST SAINT LOUIS, IL 62204-2431
(314) 482-3706
Mailing address
16544 HUNTERS CROSSING DR, WILDWOOD, MO 63040-1733
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
2008023288
MO
Other
Enumeration date
09/16/2019
Last updated
09/16/2019
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