Healthcare Provider Details

I. General information

NPI: 1518549054
Provider Name (Legal Business Name): DANIELLE BOUCHARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2021
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 N EL CIELO RD # C326
PALM SPRINGS CA
92262-6992
US

IV. Provider business mailing address

255 N EL CIELO RD # C326
PALM SPRINGS CA
92262-6992
US

V. Phone/Fax

Practice location:
  • Phone: 760-969-6535
  • Fax:
Mailing address:
  • Phone: 760-969-6535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number95223601
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberNP95026220
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: