Individual
LISA BOUCHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT, LAC
Contact information
Practice address
311 ALFRED ST, BIDDEFORD, ME 04005-3127
(207) 286-8416
(207) 286-8440
Mailing address
314 ALFRED ST, BIDDEFORD, ME 04005-3102
(207) 286-8416
(207) 286-8440
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AC209
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
043580
ANTHEM BCBS STAR #
ME
Enumeration date
06/04/2007
Last updated
01/10/2019
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