Provider Demographics
NPI:1689339244
Name:BOUCHER, NATALIE LOUISE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:LOUISE
Last Name:BOUCHER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 E 13TH ST
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MT
Mailing Address - Zip Code:59044-1828
Mailing Address - Country:US
Mailing Address - Phone:406-855-0797
Mailing Address - Fax:
Practice Address - Street 1:130 E 13TH ST
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MT
Practice Address - Zip Code:59044-1828
Practice Address - Country:US
Practice Address - Phone:406-855-0797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT179699363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily