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Individual

MICHELLE L BOURNE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
2080 HWY 9 WEST, NORMAN, OK 73072
(405) 322-6800
Mailing address
4008 WOOD CASTLE ST, NORMAN, OK 73072-1795
(405) 919-8490

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1164
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100138520A
OK
Enumeration date
07/20/2005
Last updated
02/12/2014
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