Individual
JACQUES BOUCAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NURSE PRACTITIONER
Contact information
Practice address
3800 PARK NICOLLET BLVD, ST LOUIS PARK, MN 55416-2527
(952) 993-3307
Mailing address
3691 FALCON WAY, EAGAN, MN 55123-2227
(651) 226-5523
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
9848
MN
Other
Enumeration date
01/09/2023
Last updated
01/09/2023
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