Individual
MS. NAN M BOUCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
99 CAMPUS AVE, SUITE 201, LEWISTON, ME 04240-6045
(207) 777-8810
(207) 777-8155
Mailing address
PO BOX 95000 LBX 7650, PHILADELPHIA, PA 19195-0001
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
AP081044
ME
363LG0600X
Gerontology Nurse Practitioner
Primary
CNP81044
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30347091
—
NH
05
—
432184299
—
ME
Enumeration date
06/02/2006
Last updated
11/08/2022
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