Provider Demographics
NPI:1942826060
Name:BOURKE, EVA (MSN, RNC, IBCLC)
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:
Last Name:BOURKE
Suffix:
Gender:F
Credentials:MSN, RNC, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 HOLLOW TREE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-4021
Mailing Address - Country:US
Mailing Address - Phone:203-249-6122
Mailing Address - Fax:
Practice Address - Street 1:185 HOLLOW TREE RIDGE RD
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-4021
Practice Address - Country:US
Practice Address - Phone:203-249-6122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTE53522163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant