Individual
DR. STEPHANIE LYNN BOURQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
13123 E 16TH AVE, AURORA, CO 80045-7106
(720) 777-1234
Mailing address
13123 E 16TH AVE, AURORA, CO 80045-7106
(720) 777-1234
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
52646
CO
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
52646
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
35550864
—
CO
Enumeration date
03/29/2011
Last updated
09/17/2018
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