Catherine Boucher, FNP

Individual provider Active NPI Dermatopathology Physician · Millville, DE

NPI 1457727679 · NPPES record last updated Nov 21, 2024

Key facts

NPI
1457727679
Entity type
Individual (NPI type 1)
Primary specialty
Dermatopathology Physician 207ND0900X
License
LG-0011897 (DE)
Practice address
32782 Cedar Drive
Suite 2
Millville, DE 19967
Phone
(302) 257-5089
Fax
(843) 881-5453
NPI assigned
Aug 12, 2015
Sex
Female
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes

State licenses

LicenseStateTypeSpecialty
LG-0011897DEMDDermatopathology Physician
19695SCMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Savvyderm Skin Clinic Dermatology Current
since Mar 20, 2022
Accepting new patients

Locations

32782 Cedar Dr
Unit 2
Millville, DE 19967
Phone (302) 257-5089

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 19695 SC
Family Nurse Practitioner 363LF0000X 19695 SC
Dermatopathology Physician 207ND0900X LG-0011897 DE Yes

Addresses

Primary practice location

32782 Cedar Drive
Suite 2
Millville, DE 19967

Mailing address

32782 Cedar Dr Ste 2
Millville, DE 19967-6919
Phone (302) 448-6874

Other identifiers

IdentifierTypeStateIssuer
NP3370MedicaidSC
SC77017818OtherSCMEDICARE PTAN

Other names

  • Catherine Cummings Former name

Other providers in Millville, DE

All providers in Millville, DE · Dermatopathology Physician in Delaware

Sources for this page

Verify at the official NPI Registry.