Provider Demographics
NPI:1457709826
Name:BOURET, JOANN
Entity Type:Individual
Prefix:MRS
First Name:JOANN
Middle Name:
Last Name:BOURET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5520 VAN CLEEF ST
Mailing Address - Street 2:2
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-3908
Mailing Address - Country:US
Mailing Address - Phone:917-224-4115
Mailing Address - Fax:
Practice Address - Street 1:5520 VAN CLEEF ST
Practice Address - Street 2:2
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-3908
Practice Address - Country:US
Practice Address - Phone:917-224-4115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator