Provider Demographics
NPI:1932711686
Name:BOURKE, NOA SHANNON (MSN RN)
Entity Type:Individual
Prefix:
First Name:NOA
Middle Name:SHANNON
Last Name:BOURKE
Suffix:
Gender:M
Credentials:MSN RN
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:MARIE
Other - Last Name:BOURKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2 PARTRIDGE GREEN WAY
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03867-4557
Mailing Address - Country:US
Mailing Address - Phone:603-312-0614
Mailing Address - Fax:
Practice Address - Street 1:105 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03867-2007
Practice Address - Country:US
Practice Address - Phone:603-332-3848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH063525-21163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministratorGroup - Single Specialty