Provider Demographics
NPI:1912007022
Name:BOURET, JOSEPHINE RACHEL (RNP)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:RACHEL
Last Name:BOURET
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 MIDDLESEX ST
Mailing Address - Street 2:
Mailing Address - City:MILLIS
Mailing Address - State:MA
Mailing Address - Zip Code:02054-1014
Mailing Address - Country:US
Mailing Address - Phone:508-376-5583
Mailing Address - Fax:617-248-1014
Practice Address - Street 1:251 CAUSEWAY ST
Practice Address - Street 2:ROOM 233
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2148
Practice Address - Country:US
Practice Address - Phone:617-248-1035
Practice Address - Fax:617-248-1014
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA197540363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner