Lucinda T Boudreau, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA60266597 Issued in WA

Practice address

1701 N 13TH St Ste 100
Shelton, WA 98584-2077

Phone

(360) 426-2653

NPI assigned

Oct 7, 2010

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Northwest Physician Associates PC

  • Physician Assistant
  • Arlington, WA
  • NPI 1275567919
  Medicare reassignment
• Public Hospital District No 1 of Mason County

  • Critical Access Hospital
  • Shelton, WA
  • NPI 1760568752
  Medicare reassignment
• Public Hospital District No 1 of Mason County

  • Orthopaedic Surgery Physician
  • Shelton, WA
  • NPI 1700023405
  NPD
• Franklin Medical Group, PC

  • Internal Medicine Physician
  • Waterbury, CT
  • NPI 1780686964
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1286409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612396800000",
    "number": "1598074627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1668",
            "city": "SHELTON",
            "state": "WA",
            "postal_code": "985845001",
            "telephone_number": "360-426-2653"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 N 13TH ST STE 100",
            "city": "SHELTON",
            "state": "WA",
            "postal_code": "985842077",
            "telephone_number": "360-426-2653"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUDREAU",
        "first_name": "LUCINDA",
        "middle_name": "T",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-10-07",
        "last_updated": "2021-02-04",
        "certification_date": "2021-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA60266597",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• George Blush
• Mary A Bolender, CO61603715SUDPT
• Christina Bond, CDPT
• Carola E Bonfante, M.D.
• Andrea Borja, LPN
• Steven Herschel Bowers, DDS
• Sheryl Lynn Bragg, CP 60116516
• Weston Joseph Broussard II
• Georgian Elzina Brown, M.S., L.AC.
• Julie Ann Brown

• Physician Assistant in Shelton, WA
• Providers in Shelton, WA by specialty
• Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.