Provider Demographics
NPI:1659422871
Name:BOURLIER, GERALDINE (CNP)
Entity Type:Individual
Prefix:
First Name:GERALDINE
Middle Name:
Last Name:BOURLIER
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 1:2100 COMMONWEALTH BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-1593
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3055 PLYMOUTH RD
Practice Address - Street 2:SUITE 203
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-3208
Practice Address - Country:US
Practice Address - Phone:734-769-3896
Practice Address - Fax:734-769-3746
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704078780363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics