Individual
CHARITY BOUCHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1900 WEALTHY ST SE STE 290, GRAND RAPIDS, MI 49506-2969
(616) 774-8345
Mailing address
100 MICHIGAN ST NE # MC845, GRAND RAPIDS, MI 49503-2560
(616) 486-6790
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
11/20/2015
Last updated
11/18/2021
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