Individual
JASON DAVID BOUCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
1625 DIAMOND HILL RD, WOONSOCKET, RI 02895-1771
(401) 762-1511
Mailing address
1625 DIAMOND HILL RD, WOONSOCKET, RI 02895-1771
(401) 762-1511
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
10720
RI
Other
Enumeration date
03/24/2014
Last updated
03/24/2014
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