Provider Demographics
NPI:1851088637
Name:BOUCHARD, HEATHER CARRIE (MA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:CARRIE
Last Name:BOUCHARD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7130 S 29TH ST STE G
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-5841
Mailing Address - Country:US
Mailing Address - Phone:402-890-7819
Mailing Address - Fax:
Practice Address - Street 1:7130 S 29TH ST STE G
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-5841
Practice Address - Country:US
Practice Address - Phone:402-413-6537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program