Basic Information
| Provider Information | |||||||||
| NPI: | 1659624757 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOUCHER | ||||||||
| FirstName: | CAMI | ||||||||
| MiddleName: | G. | ||||||||
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| Credential: | C.N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 944 CHERRY ST E | ||||||||
| Address2: | |||||||||
| City: | CANAL FULTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446148669 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308544574 | ||||||||
| FaxNumber: | 3308540829 | ||||||||
| Practice Location | |||||||||
| Address1: | 944 CHERRY ST E | ||||||||
| Address2: | |||||||||
| City: | CANAL FULTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446148669 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308544574 | ||||||||
| FaxNumber: | 3308540829 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2012 | ||||||||
| LastUpdateDate: | 11/01/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | COA13937NP | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.