Provider Demographics
NPI:1396408886
Name:BOURQUE, ERIN STUTES (FNP-C)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:STUTES
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 1:121 E SAINT VICTOR ST
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70510-5120
Mailing Address - Country:US
Mailing Address - Phone:337-893-0810
Mailing Address - Fax:
Practice Address - Street 1:121 E SAINT VICTOR ST
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510-5120
Practice Address - Country:US
Practice Address - Phone:337-893-0810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA222192363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily