Provider Demographics
NPI:1871825273
Name:BOUCHIE, SHARI JO (LPN)
Entity Type:Individual
Prefix:
First Name:SHARI
Middle Name:JO
Last Name:BOUCHIE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:SHARI
Other - Middle Name:JO
Other - Last Name:JOHNSHOY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:212 11TH AVENUE NORTH
Mailing Address - Street 2:APT. 204
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56501
Mailing Address - Country:US
Mailing Address - Phone:320-290-0440
Mailing Address - Fax:
Practice Address - Street 1:106 4TH AVENUE NORTH
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-1034
Practice Address - Country:US
Practice Address - Phone:218-998-3778
Practice Address - Fax:218-998-3187
Is Sole Proprietor?:No
Enumeration Date:2010-02-10
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL65463-4164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse