Individual
LISA C BOUCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1570 MIDWAY PL, MENASHA, WI 54952-1165
(920) 628-7176
Mailing address
1570 MIDWAY PL, MENASHA, WI 54952-1165
(920) 628-7176
Taxonomy
Speciality
Code
Description
License number
State
174H00000X
Health Educator
Primary
—
—
Other
Enumeration date
12/23/2020
Last updated
12/23/2020
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