Provider Demographics
NPI:1720397706
Name:BOUCHER, RACHELLE (RN/BSN)
Entity type:Individual
Prefix:
First Name:RACHELLE
Middle Name:
Last Name:BOUCHER
Suffix:
Gender:F
Credentials:RN/BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2493 E 150TH PL
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80602-8810
Mailing Address - Country:US
Mailing Address - Phone:303-833-3672
Mailing Address - Fax:
Practice Address - Street 1:2493 E 150TH PL
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80602-8810
Practice Address - Country:US
Practice Address - Phone:303-833-3672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO189302163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse