Healthcare Provider Details

I. General information

NPI: 1437634904
Provider Name (Legal Business Name): LINDA TRINH BOUCHER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2018
Last Update Date: 04/14/2026
Certification Date: 11/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 MID AMERICA PLZ DIV IM CARDIOLOGY, STE 2300
SAINT LOUIS MO
63129-0002
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-1291
  • Fax: 314-362-4278
Mailing address:
  • Phone: 314-362-1291
  • Fax: 314-362-4278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2018031646
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: