MS. LISA MARIE BOUCHER (PA-C) – Physician Assistant, NPI 1679709463

Physician Assistant

MS. LISA MARIE BOUCHER (PA-C) is a healthcare provider. based in Trenton, Michigan. specializing in Physician Assistant. They hold the professional credentials PA-C. They hold a License No. 5601005490 (MI). The NPI Number for MS. LISA MARIE BOUCHER (PA-C) is 1679709463

Main info

Female

17 Years Of Experience

Accepts Medicare Assignment

Name

MS. LISA MARIE BOUCHER (PA-C)

NPI

1679709463

Phone

(734) 391-3057

Address

1640 FORT ST

Enumeration Date

7 June 2009

Last Update Date

21 February 2017

Doctor Profile

Medical School Name

OTHER

Secondary Phone

7342847482

Graduation Year

2009 (17 years ago)

PAC ID

4183778038

Group Practice PAC ID

2264334499

Professional Enrollment ID

I20090812000514

Data current as of

20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience48

Completeness75

Years active:17State licenses:1Digital endpointsOther names

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Provider Addresses for MS. LISA MARIE BOUCHER (PA-C)

Fort Street, Trenton, Wayne County, Michigan, 48173, United States
SUITE D ATTNE DENISE
TRENTON, MI 481832040
Phone: (734) 391-3057
Fax: (734) 391-3052
Type: Mailing
Henry Ford Wyandotte Hospital, 2333, Biddle Avenue, Downtown Wyandotte, Wyandotte, Wayne County, Michigan, 48192, United States
WYANDOTTE, MI 481924668
Phone: (734) 246-6000
Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 48183)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.

PAC ID: 2264334499View full group profile

Name	Specialty	State
JAMIE ETTAHER	Certified Registered Nurse Anesthetist (Crna)	MI
JOSEPH STEPULLA (RN)	Certified Registered Nurse Anesthetist (Crna)	MI
DR. KATHRYN SHANNON MALOY (M.D., MPH)	O B S T E T R I C S/ G Y N E C O L O G Y	OH
SCOTT E BOYD (PA-C)	Physician Assistant	MI
DR. MARCIA LYNNE VANDERBROEK (DO)	-	MI
DANIEL L LONGO (CRNA)	-	MI
DR. JOYCE LEON (M.D.)	-	MI
DR. ANTHONY DWAYNE WILLIAMS (M.D.)	Gastroenterology, Internal Medicine	MI
MARCIA B KENYON (CRNA)	Certified Registered Nurse Anesthetist (Crna)	MI
DR. DAVID L WOLF (D.O.)	-	MI