Provider Demographics
NPI:1720288525
Name:BOCHICCHIO, ROSE MARIE GAUTREAUX (RN)
Entity Type:Individual
Prefix:MRS
First Name:ROSE MARIE
Middle Name:GAUTREAUX
Last Name:BOCHICCHIO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:ROSE MARIE
Other - Middle Name:
Other - Last Name:GAUTREAUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN AND RN
Mailing Address - Street 1:PO BOX 187
Mailing Address - Street 2:
Mailing Address - City:FITZWILLIAM
Mailing Address - State:NH
Mailing Address - Zip Code:03447
Mailing Address - Country:US
Mailing Address - Phone:603-831-2027
Mailing Address - Fax:603-899-6485
Practice Address - Street 1:8 BRADFORD ST
Practice Address - Street 2:
Practice Address - City:RINDGE
Practice Address - State:NH
Practice Address - Zip Code:03461
Practice Address - Country:US
Practice Address - Phone:603-831-2027
Practice Address - Fax:603-899-6485
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH04365221163W00000X
NH03222372600000X, 374U00000X
NH0322376J00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30594937Medicaid