Provider Demographics
NPI:1043445877
Name:BOURNE, JULIE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:
Last Name:BOURNE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:593 CRANBURY RD STE 1A
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-4093
Mailing Address - Country:US
Mailing Address - Phone:732-613-8880
Mailing Address - Fax:732-613-0077
Practice Address - Street 1:593 CRANBURY ROAD
Practice Address - Street 2:SUITE 1A
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816
Practice Address - Country:US
Practice Address - Phone:732-613-8880
Practice Address - Fax:732-613-0077
Is Sole Proprietor?:No
Enumeration Date:2009-05-22
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00200300363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant