Individual
LOUISE J BOUCHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SERVICE COORDINATOR
Contact information
Practice address
667 WATERMAN AVE, EAST PROVIDENCE, RI 02914-1712
(401) 438-9500
Mailing address
667 WATERMAN AVE, EAST PROVIDENCE, RI 02914-1712
(401) 438-9500
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2092
EI NHPRC
RI
01
—
292177
EI BLUE CROSS
RI
01
—
412296
EI BCHIP
RI
01
—
6400144
EI UHP
RI
05
—
ES01788
—
RI
Enumeration date
07/28/2006
Last updated
07/09/2007
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