Healthcare Provider Details

I. General information

NPI: 1336508985
Provider Name (Legal Business Name): MRS. LINDA MARIE BOUCHARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2016
Last Update Date: 02/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 FLORENCE ST
TIVERTON RI
02878-2421
US

IV. Provider business mailing address

76 FLORENCE ST
TIVERTON RI
02878-2421
US

V. Phone/Fax

Practice location:
  • Phone: 401-816-5416
  • Fax:
Mailing address:
  • Phone: 401-816-5416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code374T00000X
TaxonomyReligious Nonmedical Nursing Personnel
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: