Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Laurie A Boudreaux, PA-C

Individual provider Physician Assistant · NPI 1639307085

Laurie A Boudreaux, PA-C is a Physician Assistant in Sylvania, Ohio. Qualified in 2009, 17 years ago. Practices with Promedica Multi Specialty Physicians, a 270-clinician group and accepts Medicare assignment. Licensed in Louisiana and Ohio.

Years since qualifying
17
Licensed in
LA, OH
In the registry since
2009
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

5308 Harroun Rd Ste 280
Sylvania, OH 43560-2190
Phone: (567) 585-2080
Fax: (567) 585-2081
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 50.003687RX (OH)
Physician Assistant Taxonomy 363A00000X · Licence PA.200277 (LA)

Record details

NPI number1639307085
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedJune 24, 2009
Last updated in NPPESMarch 13, 2026
Certification dateMarch 13, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2009 (17 years in practice)
Group practice Promedica Multi Specialty Physicians — 270 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

Other providers in Sylvania