Lisa C Boucher
Individual provider Active NPI Health Educator · Menasha, WI
NPI 1447847504 · NPPES record last updated Dec 23, 2020
Key facts
- NPI
- 1447847504
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Health Educator 174H00000X
- Practice address
- 1570 Midway PL
Menasha, WI 54952-1165 - Phone
- (920) 628-7176
- NPI assigned
- Dec 23, 2020
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Health Educator | 174H00000X | Yes |
Addresses
Primary practice location
1570 Midway PL
Menasha, WI 54952-1165
Mailing address
1570 Midway PL
Menasha, WI 54952-1165
Phone (920) 628-7176
Other providers in Menasha, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 23, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.