Provider Demographics
NPI:1154663797
Name:BOURNE, ANA GABRIELA (RN)
Entity Type:Individual
Prefix:
First Name:ANA GABRIELA
Middle Name:
Last Name:BOURNE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:GABRIELA
Other - Middle Name:
Other - Last Name:BOURNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:295 FLATBUSH AVENUE EXT
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-3001
Mailing Address - Country:US
Mailing Address - Phone:718-522-1144
Mailing Address - Fax:
Practice Address - Street 1:305 7TH AVE FL 10
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6146
Practice Address - Country:US
Practice Address - Phone:212-982-8383
Practice Address - Fax:646-755-8316
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-21
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY657829-1163W00000X
NYF421132-1363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse