Provider Demographics
NPI:1407828023
Name:BOURLAND, JUDITH (RNFA)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:BOURLAND
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 EXCHANGE ST W
Mailing Address - Street 2:#222
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-1045
Mailing Address - Country:US
Mailing Address - Phone:651-602-0101
Mailing Address - Fax:651-602-0035
Practice Address - Street 1:17 EXCHANGE ST W
Practice Address - Street 2:#222
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-1045
Practice Address - Country:US
Practice Address - Phone:651-602-0101
Practice Address - Fax:651-602-0035
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1025893163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical