Provider Demographics
NPI:1861141830
Name:BOUCHER, DAWN MICHELLE (CNP)
Entity type:Individual
Prefix:MS
First Name:DAWN
Middle Name:MICHELLE
Last Name:BOUCHER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-3738
Mailing Address - Country:US
Mailing Address - Phone:740-201-6021
Mailing Address - Fax:
Practice Address - Street 1:109 N BROAD ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3738
Practice Address - Country:US
Practice Address - Phone:740-201-6021
Practice Address - Fax:740-785-4700
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-18
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.332149163W00000X
OHAPRN.CNP.0031802363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty