Provider Demographics
NPI:1902022858
Name:BOURGOIS, CAROLYN (RN)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:
Last Name:BOURGOIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 ROCKY DELLS DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-5685
Mailing Address - Country:US
Mailing Address - Phone:928-445-6426
Mailing Address - Fax:
Practice Address - Street 1:300 E GURLEY ST
Practice Address - Street 2:WASHINGTON TRADITIONAL SCHOOL
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-3823
Practice Address - Country:US
Practice Address - Phone:928-717-3281
Practice Address - Fax:928-717-3280
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN114301163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool