Individual
MYLENE BOUDREAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
75 E MCBEE AVE, GREENVILLE, SC 29601-2737
(864) 241-5199
(864) 241-5198
Mailing address
PO BOX 743294, ATLANTA, GA 30374-3294
(864) 675-4600
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
19745
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
APN.19745
SC BOARD OF NURSING
SC
Enumeration date
11/19/2015
Last updated
05/05/2017
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