Boucher, Lisa Marie

Boucher, Lisa Marie is an individual health care provider with primary practice located at 2333 Biddle Ave , Wyandotte MI 48192-4668. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Boucher, Lisa Marie can be contacted via phone (734) 246-6000.

Contact Information

Primary practice address
2333 Biddle Ave Wyandotte MI 48192-4668
Phone: (734) 246-6000
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 5601005490 Michigan

Profile Details

NPI number 1679709463
LBN Legal business name Boucher, Lisa Marie
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 7th, 2009
Last updated Feb 21st, 2017 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1679709463 NPPES
Michigan Other 0H28864 BLUE CROSS

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