| Doctor Name: | MS. NAN M BOUCHER |
| NPI Number: | 1033157227 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ANP |
| License Number: | AP081044 |
| Business Practice Address: | 99 Campus Ave Suite 201 Lewiston, ME - 042406045 |
| Business Phone Number: | 2077778810 |
| Business Fax Number: | 2077778155 |
| Mailing Address: | Po Box 1638, ALBANY |
| State: | NY |
| Postal Code: | 122011638 |
| Phone Number: | 2077774111 |
| Fax Number: | 2077836660 |
| NPI Enumeration Date: | 06/02/2006 |
| NPI Last Update Date: | 08/09/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LG0600X |
| License Number: | AP081044 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ME |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Gerontology |
| Taxonomy Definition: | |