Provider Demographics
NPI:1710922851
Name:BOURIS, MAUREEN DERMODY (RN, CDE)
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:DERMODY
Last Name:BOURIS
Suffix:
Gender:F
Credentials:RN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 PARIS ST
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-6128
Mailing Address - Country:US
Mailing Address - Phone:401-728-6811
Mailing Address - Fax:401-728-6811
Practice Address - Street 1:21 PARIS ST
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-6128
Practice Address - Country:US
Practice Address - Phone:401-728-6811
Practice Address - Fax:401-728-6811
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN29363163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI21010-8OtherBLUE CROSS/BLUE SHIELD
RI28124OtherNEIGHBORHOOD HEALTH PLAN
RI405279OtherBLUECHIP
RI63-00129OtherUNITED HEALTH CARE