Provider Demographics
NPI:1184846792
Name:BOURQUE, DONNA LOUISE (RN)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:LOUISE
Last Name:BOURQUE
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Gender:F
Credentials:RN
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Mailing Address - Street 1:280 QUARTER HORSE LN
Mailing Address - Street 2:
Mailing Address - City:SINGER
Mailing Address - State:LA
Mailing Address - Zip Code:70660-3546
Mailing Address - Country:US
Mailing Address - Phone:337-786-3245
Mailing Address - Fax:337-786-3245
Practice Address - Street 1:801 W BAYOU PINES DR
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-7076
Practice Address - Country:US
Practice Address - Phone:337-439-3205
Practice Address - Fax:337-439-0807
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
LA78482363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical