Provider Demographics
NPI:1881977924
Name:BOUCHER, JULIA (PA)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:BOUCHER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:776 LONGMEADOW ST
Mailing Address - Street 2:
Mailing Address - City:LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01106-2219
Mailing Address - Country:US
Mailing Address - Phone:413-565-4400
Mailing Address - Fax:413-565-4411
Practice Address - Street 1:776 LONGMEADOW ST
Practice Address - Street 2:
Practice Address - City:LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01106-2219
Practice Address - Country:US
Practice Address - Phone:413-565-4400
Practice Address - Fax:413-565-4411
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA4237363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant