Provider Demographics
NPI:1033677083
Name:BUCK, DESIREE BOUTIN
Entity Type:Individual
Prefix:MRS
First Name:DESIREE
Middle Name:BOUTIN
Last Name:BUCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SEMINARY HL
Mailing Address - Street 2:
Mailing Address - City:WEST LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03784-1705
Mailing Address - Country:US
Mailing Address - Phone:603-306-1783
Mailing Address - Fax:
Practice Address - Street 1:5 SEMINARY HL
Practice Address - Street 2:
Practice Address - City:WEST LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03784-1705
Practice Address - Country:US
Practice Address - Phone:603-306-1783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula