Provider Demographics
NPI:1790253763
Name:BOURNEUF, KIKI (CNM)
Entity type:Individual
Prefix:
First Name:KIKI
Middle Name:
Last Name:BOURNEUF
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:KIKI
Other - Middle Name:MARKHAM
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 14890
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12212-4890
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:518-649-4094
Practice Address - Street 1:2231 BURDETT AVE STE 110
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-2447
Practice Address - Country:US
Practice Address - Phone:518-271-3900
Practice Address - Fax:518-271-3914
Is Sole Proprietor?:No
Enumeration Date:2018-11-08
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001767176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife