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 1:32782 CEDAR DRIVE
Practice Address - Street 2:SUITE 2
Practice Address - City:MILLVILLE
Practice Address - State:DE
Practice Address - Zip Code:19967
Practice Address - Country:US
Practice Address - Phone:302-257-5089
Practice Address - Fax:843-881-5453
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19695207N00000X, 363LF0000X
DELG-0011897207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP3370Medicaid
SCSC77017818OtherMEDICARE PTAN