Provider Demographics
NPI:1750451290
Name:BOUCHER GREENE, ANDREA LYNN (RN REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:LYNN
Last Name:BOUCHER GREENE
Suffix:
Gender:F
Credentials:RN REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 ACACIA AVENUE
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95966-3658
Mailing Address - Country:US
Mailing Address - Phone:530-534-9233
Mailing Address - Fax:530-534-9200
Practice Address - Street 1:137 ACACIA AVENUE
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95966-3658
Practice Address - Country:US
Practice Address - Phone:530-534-9233
Practice Address - Fax:530-534-9200
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA528131163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse