Provider Demographics
NPI:1508530189
Name:BOUCHARD, SUSANNAH FRANCES (WHNP)
Entity Type:Individual
Prefix:DR
First Name:SUSANNAH
Middle Name:FRANCES
Last Name:BOUCHARD
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:SUSANNAH
Other - Middle Name:FRANCES
Other - Last Name:WINSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2555 N 149TH AVE
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-1692
Mailing Address - Country:US
Mailing Address - Phone:850-499-3848
Mailing Address - Fax:
Practice Address - Street 1:4175 S. ALAMO AVE
Practice Address - Street 2:BLDG 400
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85707-0000
Practice Address - Country:US
Practice Address - Phone:520-228-2778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-06
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ259659363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health