| Doctor Name: | DR. ELLEN FLORENCE BOUDREAU |
| NPI Number: | 1053325621 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D. |
| License Number: | D0035540 |
| Business Practice Address: | 1425 Porter St Fort Detrick, MD - 217029211 |
| Business Phone Number: | 3016194639 |
| Business Fax Number: | 3016192432 |
| Mailing Address: | 1425 Porter St, FORT DETRICK |
| State: | MD |
| Postal Code: | 217029211 |
| Phone Number: | 3016194639 |
| Fax Number: | 3016192432 |
| NPI Enumeration Date: | 07/28/2006 |
| NPI Last Update Date: | 12/11/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 171000000X |
| License Number: | D0035540 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Military Health Care Provider |
| Taxonomy Specialization: | |
| Taxonomy Definition: | Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. |