Provider Demographics
NPI:1316276082
Name:BOUDREAULT, MOLLY SHERRICK (NP)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:SHERRICK
Last Name:BOUDREAULT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3637 MISSION AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-2946
Mailing Address - Country:US
Mailing Address - Phone:916-482-7623
Mailing Address - Fax:916-488-7432
Practice Address - Street 1:3637 MISSION AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-2946
Practice Address - Country:US
Practice Address - Phone:916-482-7623
Practice Address - Fax:916-488-7432
Is Sole Proprietor?:No
Enumeration Date:2009-12-09
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA735471163W00000X
CA18886363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse