Individual
MS. LISA JEAN BOUCHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.A.-C
Contact information
Practice address
2 GREAT FALLS PLZ STE 21, AUBURN, ME 04210-5966
(207) 330-3950
(207) 330-3955
Mailing address
PO BOX 95000 LBX 7650, PHILADELPHIA, PA 19195-0001
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
5606
NY
363A00000X
Physician Assistant
PA646
ME
363AM0700X
Medical Physician Assistant
Primary
001342
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02209570
—
NY
Enumeration date
09/15/2006
Last updated
11/08/2022
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