Provider Demographics
NPI:1801023056
Name:BOUCHER, CHASTITY J (MSN)
Entity Type:Individual
Prefix:MRS
First Name:CHASTITY
Middle Name:J
Last Name:BOUCHER
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 ELM ST UNIT 702
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-2517
Mailing Address - Country:US
Mailing Address - Phone:973-868-9149
Mailing Address - Fax:
Practice Address - Street 1:1200 ELM ST UNIT 702
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-2517
Practice Address - Country:US
Practice Address - Phone:973-868-9149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH060582-23363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health