Provider Demographics
NPI:1700660149
Name:BOUCHARD-HORN, DACIA MICHELLE (LVN)
Entity Type:Individual
Prefix:
First Name:DACIA
Middle Name:MICHELLE
Last Name:BOUCHARD-HORN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21221 HACKETT LN
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-7935
Mailing Address - Country:US
Mailing Address - Phone:415-261-2271
Mailing Address - Fax:
Practice Address - Street 1:1147 HARTNELL AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-2113
Practice Address - Country:US
Practice Address - Phone:530-222-7213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA705747164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse