Provider Demographics
NPI:1558637405
Name:BOURNE, ELMA ANNMARIE (RN)
Entity Type:Individual
Prefix:MRS
First Name:ELMA
Middle Name:ANNMARIE
Last Name:BOURNE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:574 DUMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207
Mailing Address - Country:US
Mailing Address - Phone:718-922-2068
Mailing Address - Fax:718-922-2068
Practice Address - Street 1:574 DUMONT AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-5131
Practice Address - Country:US
Practice Address - Phone:718-922-2068
Practice Address - Fax:718-922-2068
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY398885-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool