Provider Demographics
NPI:1609458603
Name:BOUCHER, DONNA (RN)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:BOUCHER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 DERRY RD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NH
Mailing Address - Zip Code:03051-3020
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:323 DERRY RD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NH
Practice Address - Zip Code:03051-3020
Practice Address - Country:US
Practice Address - Phone:603-595-3399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH070573-21163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice