Patricia A Boudet, PA
Physician Assistant in Carbondale, IL. Individual provider (NPI-1).
NPI number1841237120
StatusActive
Last updated in NPPESMar 17, 2018
Details
- NPI
- 1841237120
- Entity type
- Individual (NPI-1)
- Name
- Patricia A Boudet
- Credential
- PA
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jun 2, 2006
- Last updated
- Mar 17, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | 085-000668 | IL | Yes |
Practice location
404 S Lewis LnCarbondale, IL 62901-3547
Phone 618-519-9200
Mailing address
Po Box 577109 California Street
Carterville, IL 62918-0577
Phone 618-985-8221 · Fax 618-985-4635
Other practice locations
400 S Lewis Ln
Carbondale, IL 62901-3547
Carbondale, IL 62901-3547
Phone 618-519-9900 · Fax 618-529-1384
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