Provider Demographics
NPI:1629595160
Name:BOURNE, DIANNE LYNN (CNP)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:LYNN
Last Name:BOURNE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 ENCINO PL NE STE 26
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2629
Mailing Address - Country:US
Mailing Address - Phone:505-884-4545
Mailing Address - Fax:505-884-4114
Practice Address - Street 1:717 ENCINO PL NE STE 26
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2629
Practice Address - Country:US
Practice Address - Phone:505-884-4545
Practice Address - Fax:505-884-4114
Is Sole Proprietor?:No
Enumeration Date:2017-08-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-03360363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner