Provider Demographics
NPI:1356682678
Name:BOUCHARD, STACEY (APRN-C)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:BOUCHARD
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:44 MAIN ST
Mailing Address - Street 2:STE 200
Mailing Address - City:RICHFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05476-1141
Mailing Address - Country:US
Mailing Address - Phone:802-255-5541
Mailing Address - Fax:802-524-7021
Practice Address - Street 1:12 CREST RD
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-9701
Practice Address - Country:US
Practice Address - Phone:802-524-4554
Practice Address - Fax:802-527-6792
Is Sole Proprietor?:No
Enumeration Date:2013-03-12
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT101.0093987363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT101.0093987OtherSTATE OF VT APRN LICENSE