Provider Demographics
NPI:1033210182
Name:BOUCHER, LISA A (MS, APRN, BC, ANP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:BOUCHER
Suffix:
Gender:F
Credentials:MS, APRN, BC, ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 FARM POND RD
Mailing Address - Street 2:
Mailing Address - City:OAKHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01068-9551
Mailing Address - Country:US
Mailing Address - Phone:508-882-3722
Mailing Address - Fax:
Practice Address - Street 1:500 SALISBURY ST
Practice Address - Street 2:ASSUMPTION COLLEGE - STUDENT HEALTH SERVICES
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1265
Practice Address - Country:US
Practice Address - Phone:508-767-7329
Practice Address - Fax:508-767-7102
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA206013363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health