Individual
CHERYL R BOURGAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA C
Contact information
Practice address
360 S GARDEN WAY, SUITE 210, EUGENE, OR 97401-8173
(541) 683-3202
(541) 868-1063
Mailing address
360 S GARDEN WAY STE 210, EUGENE, OR 97401-8186
(541) 683-3202
(541) 868-1063
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA152468
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500666195
—
OR
Enumeration date
10/06/2005
Last updated
03/27/2023
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