Individual
MURIELLE M BOURSIQUOT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
7901 HENRY AVE APT G302, PHILADELPHIA, PA 19128-3072
(267) 694-6588
Mailing address
7901 HENRY AVE APT G302, PHILADELPHIA, PA 19128-3072
(267) 694-6588
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
29785595
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
203711803
SANFORD BROWN
PA
Enumeration date
08/06/2020
Last updated
08/06/2020
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