Provider Demographics
NPI:1154549632
Name:BOUCAUD, DEBRA ANNE MARIE (NP)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:ANNE MARIE
Last Name:BOUCAUD
Suffix:
Gender:F
Credentials:NP
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Other - Credentials:
Mailing Address - Street 1:7440 MOLAS RD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-6435
Mailing Address - Country:US
Mailing Address - Phone:479-522-4771
Mailing Address - Fax:
Practice Address - Street 1:24 HOSPITAL LN
Practice Address - Street 2:
Practice Address - City:CALAIS
Practice Address - State:ME
Practice Address - Zip Code:04619-1329
Practice Address - Country:US
Practice Address - Phone:479-926-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT8816363LA2200X
NY30304076363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health