Provider Demographics
NPI:1710142799
Name:BOUCHER, DEBORA A (APRN-FPA, CNM)
Entity Type:Individual
Prefix:MS
First Name:DEBORA
Middle Name:A
Last Name:BOUCHER
Suffix:
Gender:F
Credentials:APRN-FPA, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40826 N RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:IL
Mailing Address - Zip Code:60002-9545
Mailing Address - Country:US
Mailing Address - Phone:847-975-7115
Mailing Address - Fax:888-959-0674
Practice Address - Street 1:40826 N RIDGE CIR
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:IL
Practice Address - Zip Code:60002-9545
Practice Address - Country:US
Practice Address - Phone:847-975-7115
Practice Address - Fax:888-959-0674
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-19
Last Update Date:2023-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.349335163W00000X
IL209007144367A00000X
IL277000293367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse