Provider Demographics
NPI:1811218266
Name:BOURNE, THOMAS J (RN)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:J
Last Name:BOURNE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15436 BEL RED RD
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-5536
Mailing Address - Country:US
Mailing Address - Phone:425-644-4100
Mailing Address - Fax:
Practice Address - Street 1:9617 7TH AVE SE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-3710
Practice Address - Country:US
Practice Address - Phone:425-513-8509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60125138163WP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0000XNursing Service ProvidersRegistered NursePain Management