Provider Demographics
NPI:1013385442
Name:BOUCHARD, HALEY (RD, PA-C)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:BOUCHARD
Suffix:
Gender:F
Credentials:RD, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 CLARK WAY
Mailing Address - Street 2:
Mailing Address - City:SOMERSWORTH
Mailing Address - State:NH
Mailing Address - Zip Code:03878-4401
Mailing Address - Country:US
Mailing Address - Phone:603-692-2228
Mailing Address - Fax:603-692-4748
Practice Address - Street 1:21 CLARK WAY
Practice Address - Street 2:
Practice Address - City:SOMERSWORTH
Practice Address - State:NH
Practice Address - Zip Code:03878-4401
Practice Address - Country:US
Practice Address - Phone:603-692-2228
Practice Address - Fax:603-692-4748
Is Sole Proprietor?:No
Enumeration Date:2015-09-02
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0704133V00000X
NH1580207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered