Organization
JORDAN BOUCHER
Active
Other names
Lively Greens
Organization subpart
No
Provider details
NPI number
Authorized official
JORDAN LYNN BOUCHER RD (REGISTERED DIETITIAN)
(713) 689-9673
Entity
Organization
Contact information
Practice address
3333 SE HORSTMAN RD, PORT ORCHARD, WA 98366-4054
(713) 689-9673
Mailing address
3333 SE HORSTMAN RD, PORT ORCHARD, WA 98366-4054
(713) 689-9673
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DI 60543717
WA
Other
Enumeration date
04/24/2015
Last updated
04/24/2015
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