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General NPI Number Information
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NPI Number | 1992283782
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Entity Type | Individual
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Provider Name | LAUREN NICOLE BOUCHIE PA
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Gender | Female
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Dates
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Enumeration Date | 08/02/2018
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Last Update Date | 04/20/2023
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Provider Practice Location Address
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Address Line | 1805 S STATE ROAD 57
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City | WASHINGTON
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State | IN
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Zip | 47501-4326
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Country | US
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Telephone | 812-254-7845
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Fax | 812-254-5989
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Provider Business Mailing Address
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Address Line | PO BOX 760
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City | WASHINGTON
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State | IN
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Zip | 47501-0760
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Country | US
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Telephone | 812-254-7310
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Fax | 812-257-8062
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10002473A
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License Number State | IN
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