Provider Demographics
NPI:1114334836
Name:BOURASSA, LORI (PHD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:
Last Name:BOURASSA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1959 NE PACIFIC ST # NW120
Mailing Address - Street 2:BOX 357110
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-7110
Mailing Address - Country:US
Mailing Address - Phone:617-794-5928
Mailing Address - Fax:
Practice Address - Street 1:1959 NE PACIFIC ST # NW120
Practice Address - Street 2:BOX 357110
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-7110
Practice Address - Country:US
Practice Address - Phone:617-794-5928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0900XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMicrobiology