Provider Demographics
NPI:1003884685
Name:BOUCHARD, BONNIE (CNM)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:BOUCHARD
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:CARIBOU
Mailing Address - State:ME
Mailing Address - Zip Code:04736-0040
Mailing Address - Country:US
Mailing Address - Phone:207-498-2359
Mailing Address - Fax:207-498-3947
Practice Address - Street 1:163 VAN BUREN RD STE 4
Practice Address - Street 2:
Practice Address - City:CARIBOU
Practice Address - State:ME
Practice Address - Zip Code:04736-3567
Practice Address - Country:US
Practice Address - Phone:207-498-6921
Practice Address - Fax:207-498-1697
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN27700163W00000X
MECNM82022176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME11459629OtherCAQH ID NO.
8891249OtherCIGNA PROVIDER ID NO.
2426723OtherUNITED HEALTHCARE PROVIDER NO.