Provider Demographics
NPI:1932331717
Name:BOUCHE, RANDY JOHN (RN)
Entity Type:Individual
Prefix:MR
First Name:RANDY
Middle Name:JOHN
Last Name:BOUCHE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 S SUNNYVALE LN
Mailing Address - Street 2:UNIT D
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-3371
Mailing Address - Country:US
Mailing Address - Phone:608-276-6082
Mailing Address - Fax:
Practice Address - Street 1:1026 S SUNNYVALE LN
Practice Address - Street 2:UNIT D
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-3371
Practice Address - Country:US
Practice Address - Phone:608-276-6082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-13
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI167379-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse