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General NPI Number Information
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NPI Number | 1699311753
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Entity Type | Individual
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Provider Name | MIRYAM AMELIE BOUCHER NP-C
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Gender | Female
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Dates
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Enumeration Date | 11/25/2019
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Last Update Date | 06/20/2025
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Provider Practice Location Address
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Address Line | 450 CLINTON ST
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City | WOONSOCKET
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State | RI
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Zip | 02895-3207
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Country | US
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Telephone | 401-767-4100
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Fax |
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Provider Business Mailing Address
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Address Line | 450 CLINTON ST
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City | WOONSOCKET
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State | RI
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Zip | 02895-3207
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Country | US
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Telephone | 401-767-4100
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 58023
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN2319289
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 02226
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License Number State | RI
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