Provider Demographics
NPI:1487536355
Name:BOUDREAUX, CINDY MARIE
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:MARIE
Last Name:BOUDREAUX
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 1:120 RICHFIELD TER
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-3743
Mailing Address - Country:US
Mailing Address - Phone:864-275-4341
Mailing Address - Fax:864-275-4341
Practice Address - Street 1:120 RICHFIELD TER
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-3743
Practice Address - Country:US
Practice Address - Phone:864-275-4341
Practice Address - Fax:864-275-4341
Is Sole Proprietor?:No
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC30715363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily