Individual
ELAINE RUSSO BOUCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
850 HARRISON AVE, YACC 4, BOSTON, MA 02118-4001
(617) 414-2080
(617) 414-2090
Mailing address
720 HARRISON AVE, DOB 503, BOSTON, MA 02118
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
RN106293
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110086937A
—
MA
Enumeration date
08/13/2010
Last updated
05/08/2014
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