Individual
STACEY W. BOUDOIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
635 LAFITTE ST STE B, MANDEVILLE, LA 70448-5269
(985) 624-5305
(985) 624-8643
Mailing address
635 LAFITTE ST, STE B, MANDEVILLE, LA 70448-5269
(985) 624-5305
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
RN072251
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04002873
—
MS
05
—
1468584
—
LA
Enumeration date
04/26/2006
Last updated
03/17/2018
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