Provider Demographics
NPI:1215622188
Name:BOUDREAU, ALYSON RAYNOR
Entity type:Individual
Prefix:
First Name:ALYSON
Middle Name:RAYNOR
Last Name:BOUDREAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 IRVING ST. NW
Mailing Address - Street 2:DEPT. OF PODIATRIC SURGERY
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010
Mailing Address - Country:US
Mailing Address - Phone:202-882-7917
Mailing Address - Fax:
Practice Address - Street 1:110 IRVING ST. NW
Practice Address - Street 2:DEPT. OF PODIATRIC SURGERY
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010
Practice Address - Country:US
Practice Address - Phone:202-882-7917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program