Provider Demographics
NPI:1952640948
Name:BOURNE, ERIKA (RN, CMTPT)
Entity Type:Individual
Prefix:MS
First Name:ERIKA
Middle Name:
Last Name:BOURNE
Suffix:
Gender:F
Credentials:RN, CMTPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 ARLINGTON ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-2090
Mailing Address - Country:US
Mailing Address - Phone:781-894-9430
Mailing Address - Fax:
Practice Address - Street 1:203 ARLINGTON ST
Practice Address - Street 2:SUITE 1
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-2090
Practice Address - Country:US
Practice Address - Phone:781-894-9430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN234770163WP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0000XNursing Service ProvidersRegistered NursePain Management