Provider Demographics
NPI:1699415547
Name:BOURQUE, ERIN (FNP-C)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:BOURQUE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 EMERY MILLS RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:ME
Mailing Address - Zip Code:04027-3129
Mailing Address - Country:US
Mailing Address - Phone:505-803-4469
Mailing Address - Fax:
Practice Address - Street 1:55 EMERY MILLS RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:ME
Practice Address - Zip Code:04027-3129
Practice Address - Country:US
Practice Address - Phone:505-803-4469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN66600163WE0003X
NH087754-23363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WE0003XNursing Service ProvidersRegistered NurseEmergency