MEDICARE: MRS. ANDREA LYNN BOUCHER RN REGISTERED NURSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	528131	CA

General Provider Information

NPI Number	:	1750451290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANDREA LYNN BOUCHER RN REGISTERED NURSE

Provider Business Mailing Address
First Line	:	10272 MELODY RD
Second Line	:
City	:	BIG OAK VALLEY
State	:	CA
Zip	:	95977-9536
Country	:	US
Telephone Number	:	530-446-4600
Fax Number	:

Provider Business Practice Location Address
First Line	:	10272 MELODY RD
Second Line	:
City	:	BIG OAK VALLEY
State	:	CA
Zip	:	95977-9536
Country	:	US
Telephone Number	:	530-446-4600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	12/10/2024

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