NPI 1366716102

Janelle L Kyllo Bouchie, PAC

Practitioner Physician Assistant Detroit Lakes, MN

Practice location

Address: 1027 Washington Ave, Detroit Lakes, MN 56501-3409
Phone: (218) 847-5611
Mailing address: 1702 University Dr S, Fargo, ND 58103-4940

Registered specialties (2)

Physician Assistant Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363A00000X Licence 12809 (MN)

Other Physician Assistant providers in Minnesota →

Pediatric Occupational Therapist

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 225XP0200X Licence OT-1120 (ID)

Other Occupational Therapist providers in Minnesota →

Registry record

NPI: 1366716102
Entity type: Individual
Sex (as registered): Female
NPI issued: 24 Feb 2012
Record last updated: 10 Nov 2021

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.