NPI 1063923175 · live from the CMS NPI Registry
Nicole Bourque, PA-C
Physician Assistant in Boston, MA. National Provider Identifier 1063923175, active.
NPI record
| NPI | 1063923175 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Physician Assistant 363A00000X |
| Practice location | 75 Francis St, Boston, MA 02115 |
| Practice phone | 603-508-1922 |
| Mailing address | 132 Hobbs Rd, Pelham, NH 03076 |
| Enumerated | October 16, 2017 |
| Last updated | October 16, 2017 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Physician Assistant primary | 363A00000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.