Provider Demographics
NPI:1215596531
Name:BOURQUE, ELEANOR HEBERT (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:ELEANOR
Middle Name:HEBERT
Last Name:BOURQUE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 N SCOTTSDALE RD STE 240
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85257-3594
Mailing Address - Country:US
Mailing Address - Phone:480-900-7256
Mailing Address - Fax:480-900-7256
Practice Address - Street 1:450 S WILLARD ST STE 103
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-6744
Practice Address - Country:US
Practice Address - Phone:928-634-9573
Practice Address - Fax:928-634-0135
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA206214363LF0000X
AZ296958363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily