Active NPI
Emily Boudewyns, RDH
- Dental Hygienist
- Hartford, CT
National Provider Identifier
1649417288
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 007294
- Practice address
- 21 Grand St
Hartford, CT 06106-1541 - Phone
- (860) 550-7500
- Fax
- (860) 550-7501
- NPI assigned
- Jan 20, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 007294 | CT | Primary |
Addresses
Primary practice location
21 Grand St
Hartford, CT 06106-1541
Mailing address
21 Grand St
Hartford, CT 06106-1541
Phone (860) 550-7500
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004235992 | Medicaid | CT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 007294 | CT | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1232409600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1290124800000",
"number": "1649417288",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21 GRAND ST",
"city": "HARTFORD",
"state": "CT",
"postal_code": "061061541",
"telephone_number": "860-550-7500",
"fax_number": "860-550-7501"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21 GRAND ST",
"city": "HARTFORD",
"state": "CT",
"postal_code": "061061541",
"telephone_number": "860-550-7500",
"fax_number": "860-550-7501"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUDEWYNS",
"first_name": "EMILY",
"name_prefix": "Ms.",
"credential": "RDH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-01-20",
"last_updated": "2010-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "CT",
"license": "007294",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "004235992",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hartford, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.