Individual
RAEGEN HARBOUR BOUDREAUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1717 SAINT CHARLES AVE, NEW ORLEANS, LA 70130-5223
(504) 529-6600
Mailing address
5262 WOODSIDE DR, BATON ROUGE, LA 70808-1951
(225) 315-9224
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
310483
LA
Other
Enumeration date
08/29/2018
Last updated
07/07/2022
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