Provider Demographics
NPI:1154488070
Name:BOUCHER, HEATHER K (RN CNM)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:K
Last Name:BOUCHER
Suffix:
Gender:F
Credentials:RN CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 PEAK ONE DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:CO
Mailing Address - Zip Code:80443
Mailing Address - Country:US
Mailing Address - Phone:970-668-5771
Mailing Address - Fax:970-262-2196
Practice Address - Street 1:360 PEAK ONE DRIVE
Practice Address - Street 2:SUITE 260
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443
Practice Address - Country:US
Practice Address - Phone:970-668-5771
Practice Address - Fax:970-262-2196
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO128964163WX0003X
COAPN.0004757-CNM367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO128964OtherCOLORADO STATE LICENSE