Jeanne M Boudrieau, ARNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP30004530 Issued in WA

Practice address

1450 Northwest LN SE
Providence St. Peter Clinic at Panorama
Lacey, WA 98503-6908

Phone

(360) 491-4460

Fax

(360) 491-3090

NPI assigned

Feb 11, 2006

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

Other identifiers 1

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

Credentials

Nurse Practitioner

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.

• Sea Mar Community Health Centers

  • Federally Qualified Health Center (FQHC)
  • Aberdeen, WA
  • NPI 1811051170

  Family

  Medicare reassignment NPD
• Sea Mar Community Health Centers

  • Federally Qualified Health Center (FQHC)
  • Lacey, WA
  • NPI 1700101797
  NPD
• Sea Mar Community Health Centers

  • Federally Qualified Health Center (FQHC)
  • Spanaway, WA
  • NPI 1922624642
  NPD
• GHCH Physician Services, LLC

  • Surgery Physician
  • Aberdeen, WA
  • NPI 1326217670
  NPD (past)

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

{
    "created_epoch": "1139616000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1393459200000",
    "number": "1669445359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1450 NORTHWEST LN SE",
            "address_2": "PROVIDENCE ST. PETER CLINIC AT PANORAMA",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985036908",
            "telephone_number": "360-491-4460",
            "fax_number": "360-491-3090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1450 NORTHWEST LN SE",
            "address_2": "PROVIDENCE ST. PETER CLINIC AT PANORAMA",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985036908",
            "telephone_number": "360-491-4460",
            "fax_number": "360-491-3090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUDRIEAU",
        "first_name": "JEANNE",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-11",
        "last_updated": "2014-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP30004530",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9621798",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Julieta Quia Bonilla, RN
• Erica Bonte
• Emily Chepngeno Bor, BSN,RN
• Kerri Borden, CC
• Shelly Boss, RN
• Michele Nordgren Bourque, LMFT
• Bryce Bowles, OD
• Lonnie E Bowling
• Brittany Bowman
• Dave Boyd, MFTA

• Family Nurse Practitioner in Lacey, WA
• Providers in Lacey, WA by specialty
• Family Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2014; 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.