Provider Demographics
NPI:1336487776
Name:BOUSEL, PATIENCE MEIGS (LMT, CSE, CTP)
Entity Type:Individual
Prefix:
First Name:PATIENCE
Middle Name:MEIGS
Last Name:BOUSEL
Suffix:
Gender:F
Credentials:LMT, CSE, CTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 HEATHERSTONE RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-1638
Mailing Address - Country:US
Mailing Address - Phone:413-218-7815
Mailing Address - Fax:413-253-3846
Practice Address - Street 1:800 MAIN ST
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2854
Practice Address - Country:US
Practice Address - Phone:413-218-7815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2953261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain