Provider Demographics
NPI:1265700710
Name:BOUCHER, JUNE ELLEN (RN)
Entity type:Individual
Prefix:MRS
First Name:JUNE
Middle Name:ELLEN
Last Name:BOUCHER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 STATE STREET
Mailing Address - Street 2:JOHN EDWARDS ELEMENTARY SCHOOL
Mailing Address - City:HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12534
Mailing Address - Country:US
Mailing Address - Phone:518-828-9493
Mailing Address - Fax:518-697-8516
Practice Address - Street 1:360 STATE ST
Practice Address - Street 2:JOHN EDWARDS ELEMENTARY SCHOOL
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534-0000
Practice Address - Country:US
Practice Address - Phone:518-828-9493
Practice Address - Fax:518-697-8516
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY500201163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY500201OtherNURSING LICENSE