Healthcare Provider Details

I. General information

NPI: 1992283782
Provider Name (Legal Business Name): LAUREN NICOLE BOUCHIE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN NICOLE CARDINAL PA-C

II. Dates (important events)

Enumeration Date: 08/02/2018
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S 7TH ST HEALTH PAVILION SB 406
VINCENNES IN
47591-1038
US

IV. Provider business mailing address

520 S 7TH ST HEALTH PAVILION SB 406
VINCENNES IN
47591-1038
US

V. Phone/Fax

Practice location:
  • Phone: 812-885-8770
  • Fax: 812-885-8771
Mailing address:
  • Phone: 812-885-8770
  • Fax: 812-885-8771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10002473A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: