Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 01072482A | IN |
Y | 111NI0900X | Internist | 01072482A | IN |
NPI | 1003131871 |
---|---|
Provider Name | Mrs. Samantha Dawn Bouchie |
First Address | Indianapolis, IN 46250-2890 |
Second Address | Noblesville, IN 46060-5005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2010 |
Last Update Date | 02/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201117770 | (05) | IN |