Provider Demographics
NPI:1831241272
Name:BOURNE, JEANETTE LILLIAN (MD)
Entity type:Individual
Prefix:DR
First Name:JEANETTE
Middle Name:LILLIAN
Last Name:BOURNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2728 EVANS DAIRY RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28312-7194
Mailing Address - Country:US
Mailing Address - Phone:919-827-7766
Mailing Address - Fax:
Practice Address - Street 1:340 SEMINARY ST
Practice Address - Street 2:
Practice Address - City:KENANSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28349-8978
Practice Address - Country:US
Practice Address - Phone:910-296-2130
Practice Address - Fax:910-296-2139
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9300658207V00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology