Provider Demographics
NPI:1568125797
Name:BOUCHER, HILARY RAE (PA)
Entity Type:Individual
Prefix:
First Name:HILARY
Middle Name:RAE
Last Name:BOUCHER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 NORTH ST STE 4
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-2295
Mailing Address - Country:US
Mailing Address - Phone:207-768-4000
Mailing Address - Fax:
Practice Address - Street 1:23 NORTH ST STE 4
Practice Address - Street 2:
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-2295
Practice Address - Country:US
Practice Address - Phone:207-768-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA2274363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant