Individual
JEANNE M BOURGET
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4410 106TH ST SW, MUKILTEO, WA 98275-4700
(425) 388-6004
Mailing address
PO BOX 5127, EVERETT, WA 98206-5127
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP30001711
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9602152
—
WA
01
—
AP30001711
LICENSE
—
Enumeration date
11/09/2006
Last updated
12/06/2012
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