Provider Demographics
NPI:1801834817
Name:BOURQUE, KATHLEEN (APRN)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:BOURQUE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:248 PLEASANT ST
Mailing Address - Street 2:SUITE 2600
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2588
Mailing Address - Country:US
Mailing Address - Phone:603-228-7400
Mailing Address - Fax:603-228-7403
Practice Address - Street 1:248 PLEASANT ST
Practice Address - Street 2:SUITE 2600
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2588
Practice Address - Country:US
Practice Address - Phone:603-228-7400
Practice Address - Fax:603-228-7403
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH019376-21363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHR74588Medicare UPIN