Active NPI
Alisa Boucher, MS
- Nutritionist
- Waterford, MI
National Provider Identifier
1629740113
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nutritionist
- Practice address
- 4233 Island Park Dr
Waterford, MI 48329-1916 - Phone
- (248) 468-6823
- NPI assigned
- Oct 2, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nutrition Education Nutritionist | 133NN1002X | |||
| Nutritionist | 133N00000X | Primary |
Addresses
Primary practice location
4233 Island Park Dr
Waterford, MI 48329-1916
Mailing address
7111 Dixie Hwy Ste 362
Clarkston, MI 48346-2077
Phone (248) 468-6823
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | 248-970-1938 | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1633132800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1633132800000",
"number": "1629740113",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7111 DIXIE HWY STE 362",
"city": "CLARKSTON",
"state": "MI",
"postal_code": "483462077",
"telephone_number": "248-468-6823"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4233 ISLAND PARK DR",
"city": "WATERFORD",
"state": "MI",
"postal_code": "483291916",
"telephone_number": "248-468-6823"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUCHER",
"first_name": "ALISA",
"credential": "MS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-10-02",
"last_updated": "2021-10-02",
"certification_date": "2021-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "133NN1002X",
"taxonomy_group": "",
"desc": "Nutritionist, Nutrition, Education",
"state": null,
"license": null,
"primary": false
},
{
"code": "133N00000X",
"taxonomy_group": "",
"desc": "Nutritionist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "248-970-1938",
"affiliation": "N",
"endpointDescription": "Fax",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "HIPAA Compliant EMR direct Fax Number",
"address_1": "7111 Dixie Hwy Ste 362",
"city": "Clarkston",
"state": "MI",
"country_code": "US",
"postal_code": "483462077",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Waterford, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.