Provider Demographics
NPI:1841602299
Name:BOUCHARD, BEVERLEY L (CPM, LM)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLEY
Middle Name:L
Last Name:BOUCHARD
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 HANOVER CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-6209
Mailing Address - Country:US
Mailing Address - Phone:540-688-9100
Mailing Address - Fax:
Practice Address - Street 1:1003 MAHONE ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-6214
Practice Address - Country:US
Practice Address - Phone:540-318-0055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-20
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAPENDING176B00000X
374J00000X
VACPM22050016176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0129000176OtherVIRGINIA DEPARTMENT OF HEALTH PROFESSIONALS
VA99499OtherCPT