Provider Demographics
NPI:1841381506
Name:BOUGHAN, AMY L (ANP)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:L
Last Name:BOUGHAN
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
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Mailing Address - Street 1:40 GATSBY DR
Mailing Address - Street 2:UNIT # 7
Mailing Address - City:RAYNHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02767-8075
Mailing Address - Country:US
Mailing Address - Phone:508-884-3440
Mailing Address - Fax:
Practice Address - Street 1:45 FRANCIS ST
Practice Address - Street 2:BWH WEINER CENTER
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6105
Practice Address - Country:US
Practice Address - Phone:617-732-5179
Practice Address - Fax:617-975-0885
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA170873363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health