Provider Demographics
NPI:1467493023
Name:BOUCHARD, DENISE M (DNPC)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:M
Last Name:BOUCHARD
Suffix:
Gender:F
Credentials:DNPC
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:M
Other - Last Name:BOUCHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 1599
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-1599
Mailing Address - Country:US
Mailing Address - Phone:207-404-8200
Mailing Address - Fax:207-947-0435
Practice Address - Street 1:53 SCHOODIC DR
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915
Practice Address - Country:US
Practice Address - Phone:207-338-6900
Practice Address - Fax:207-338-4974
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP81546363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MENP522001Medicare PIN
MEQ59057Medicare UPIN
MENP5220Medicare PIN