Provider Demographics
NPI:1801573688
Name:BOUCHER, JANET A
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:A
Last Name:BOUCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2064 PACER TRL
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45434-5624
Mailing Address - Country:US
Mailing Address - Phone:937-475-0431
Mailing Address - Fax:
Practice Address - Street 1:2064 PACER TRL
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45434-5624
Practice Address - Country:US
Practice Address - Phone:937-475-0431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No171R00000XOther Service ProvidersInterpreter