Jamie David Boudreau, ATC
Individual provider Active NPI Athletic Trainer · Derry, NH
NPI 1780146688 · NPPES record last updated Apr 1, 2019
Key facts
- NPI
- 1780146688
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- License
- 0072 (NH)
- Practice address
- 19 N Main St
Derry, NH 03038-1208 - Phone
- (603) 437-5200
- Fax
- (603) 437-5244
- NPI assigned
- Apr 1, 2019
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0072 | NH | MD | Athletic Trainer |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 0072 | NH | Yes |
Addresses
Primary practice location
19 N Main St
Derry, NH 03038-1208
Mailing address
114 Helen Dearborn Rd
Weare, NH 03281-5816
Phone (603) 437-5200
Other providers in Derry, NH
- Corrine Mary Bond
- Debra Boniface
- Phillip A. Bordonaro
- Heather Lynn Bortz
- Taylor Elanna Bosco
- Alexis Boyatsis
- Shannon Melissa Brancieri
- Brenda D Berkal DMD PC
- Brian D Tedesco, DPM & George a Abboud DPM PC
- Brian Fradette
All providers in Derry, NH · Athletic Trainer in New Hampshire
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 1, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.