Provider Demographics
NPI:1639340995
Name:BOUCHER, BARBARA LYNN (NP)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:LYNN
Last Name:BOUCHER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 W FOREST HOME AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-2843
Mailing Address - Country:US
Mailing Address - Phone:414-389-2377
Mailing Address - Fax:920-445-7289
Practice Address - Street 1:3237 VOYAGER DR
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-8349
Practice Address - Country:US
Practice Address - Phone:920-468-8288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-14
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3371-033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI11014110Medicaid
WI521310Medicare Oscar/Certification
WI075100154Medicare Oscar/Certification
WI330350048Medicare Oscar/Certification
WI401600072Medicare Oscar/Certification
WI030280048Medicare Oscar/Certification
073550110Medicare Oscar/Certification
WIK400102998Medicare Oscar/Certification
WI072900074Medicare Oscar/Certification
WI078450068Medicare Oscar/Certification