Provider Demographics
NPI:1962719369
Name:DUPRE, AMANDA BOUDREAU (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:BOUDREAU
Last Name:DUPRE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17958 JEFFERSON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-9535
Mailing Address - Country:US
Mailing Address - Phone:225-276-4777
Mailing Address - Fax:225-361-0616
Practice Address - Street 1:1700 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-3246
Practice Address - Country:US
Practice Address - Phone:225-752-2470
Practice Address - Fax:225-755-4883
Is Sole Proprietor?:No
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LARN082910-AP06277363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily