Provider Demographics
NPI:1952536807
Name:BOURGEOIS, JAMIE J (CNM)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:J
Last Name:BOURGEOIS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:J
Other - Last Name:SPENCER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 WALL ST STE 200
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-1518
Mailing Address - Country:US
Mailing Address - Phone:603-668-4111
Mailing Address - Fax:603-622-4134
Practice Address - Street 1:2 WALL ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-1518
Practice Address - Country:US
Practice Address - Phone:603-668-4111
Practice Address - Fax:603-622-4134
Is Sole Proprietor?:No
Enumeration Date:2009-05-21
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH054241-23176B00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No176B00000XOther Service ProvidersMidwife