| Doctor Name: | RENEE M BOUCHER |
| NPI Number: | 1699750034 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | 230888 |
| Business Practice Address: | 3 Memorial Dr Winchendon, MA - 014751279 |
| Business Phone Number: | 9782975052 |
| Business Fax Number: | 9782975430 |
| Mailing Address: | 242 Green St, GARDNER |
| State: | MA |
| Postal Code: | 014401336 |
| Phone Number: | 9786305076 |
| Fax Number: | 9786305078 |
| NPI Enumeration Date: | 12/08/2005 |
| NPI Last Update Date: | 01/21/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 230888 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |