Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | CNM82022 | ME |
NPI | 1003884685 |
---|---|
Provider Name | Bonnie Bouchard |
First Address | Caribou, ME 04736-0040 |
Second Address | Caribou, ME 04736-3567 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2006 |
Last Update Date | 17/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11459629 | CAQH ID NO. (01) | ME |
2426723 | UNITED HEALTHCARE PROVIDER NO. (01) | |
8891249 | CIGNA PROVIDER ID NO. (01) | |
P08280 | (02) |