Provider Demographics
NPI:1457727679
Name:BOUCHER, CATHERINE (FNP)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:BOUCHER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:
Other - Last Name:CUMMINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:32782 CEDAR DR STE 2
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19967-6919
Mailing Address - Country:US
Mailing Address - Phone:302-448-6874
Mailing Address - Fax:
Practice Address - Street 1:570 LONG POINT RD STE 200
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-7940
Practice Address - Country:US
Practice Address - Phone:843-881-0320
Practice Address - Fax:843-881-5453
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2022-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19695207N00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSC77017818OtherMEDICARE PTAN
SCNP3370Medicaid