Individual
JENNIFER S BOUCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
19020 FORT ST, RIVERVIEW, MI 48193-6701
(734) 362-5100
(734) 362-5147
Mailing address
19020 FORT ST, RIVERVIEW, MI 48193-6701
(734) 362-5100
(734) 362-5147
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704180289
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704180289
NP SPECIALTY BOARD CERT
MI
Enumeration date
09/27/2006
Last updated
07/08/2007
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