Provider Demographics
NPI:1427185750
Name:BOURGEOIS, PAULA M (LPN)
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:M
Last Name:BOURGEOIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:362 S RAILROAD ST
Mailing Address - Street 2:P.O. BOX 495
Mailing Address - City:PARISH
Mailing Address - State:NY
Mailing Address - Zip Code:13131-3370
Mailing Address - Country:US
Mailing Address - Phone:315-625-7275
Mailing Address - Fax:
Practice Address - Street 1:8 N 8TH ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-1435
Practice Address - Country:US
Practice Address - Phone:315-592-4093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY281780-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02749700Medicaid