Provider Demographics
NPI:1124447883
Name:BOUCHER, HEATHER ANNE (RN-BSN, MSM)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANNE
Last Name:BOUCHER
Suffix:
Gender:F
Credentials:RN-BSN, MSM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 HARRISBURG AVE
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-2153
Mailing Address - Country:US
Mailing Address - Phone:207-317-1649
Mailing Address - Fax:
Practice Address - Street 1:110 HARRISBURG AVE
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-2153
Practice Address - Country:US
Practice Address - Phone:207-317-1649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-10
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN049953163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse