Provider Demographics
NPI:1366710592
Name:BOUDREAU, BARBARA CELINA (RN)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:CELINA
Last Name:BOUDREAU
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1841 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08757-2126
Mailing Address - Country:US
Mailing Address - Phone:732-736-7459
Mailing Address - Fax:
Practice Address - Street 1:1228 ROUTE 37 WEST
Practice Address - Street 2:HOLY REDEEMER
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08759
Practice Address - Country:US
Practice Address - Phone:732-240-2449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR12987700163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse