Individual
MS. MARY ELLEN BOUDREAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP (AGPCNP-BC)
Contact information
Practice address
790 E COLUMBIA ST, MASON, MI 48854-1387
(517) 244-0120
Mailing address
790 E COLUMBIA ST, MASON, MI 48854-1387
(517) 244-0120
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
6801065539
MI
163WC1500X
Community Health Registered Nurse
4704265711
MI
363LP2300X
Primary Care Nurse Practitioner
Primary
4704265711
MI
Other
Enumeration date
04/24/2013
Last updated
01/29/2014
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