Individual
KARISSA BOURBEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
44 MARGATE AVE, MARMORA, NJ 08223-1603
(609) 816-4789
Mailing address
44 MARGATE AVE, MARMORA, NJ 08223-1603
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
25MP00570500
NJ
Other
Enumeration date
05/08/2020
Last updated
08/25/2020
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