Individual
PATRICIA A BOUDET
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
404 S LEWIS LN, CARBONDALE, IL 62901-3547
(618) 519-9200
Mailing address
PO BOX 577, 109 CALIFORNIA STREET, CARTERVILLE, IL 62918-0577
(618) 985-8221
(618) 985-4635
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085-000668
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085-000668
STATE PA MEDICAL LICENSE
IL
05
—
370966854024
—
IL
Enumeration date
06/02/2006
Last updated
03/17/2018
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