Individual
CHRISTOPHER BOURGET
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2 GOOD SAMARITAN WAY, MEDICAL PLAZA SUITE 205, MOUNT VERNON, IL 62864-2408
(618) 241-1108
Mailing address
2 GOOD SAMARITAN WAY, MEDICAL PLAZA SUITE 205, MOUNT VERNON, IL 62864-2408
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
183149
TN
163WC0200X
Critical Care Medicine Registered Nurse
183149
TN
367500000X
Certified Registered Nurse Anesthetist
Primary
209013864
IL
Other
Enumeration date
09/01/2015
Last updated
10/01/2020
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