Individual
GLORIA G BOURQUE
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
1919 LATHROP ST, STE 220, FAIRBANKS, AK 99701
(907) 452-1739
(907) 452-2384
Mailing address
PO BOX 73410, FAIRBANKS, AK 99707-3410
(800) 478-4091
(907) 770-2390
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
545
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0221
—
AK
05
—
NP0545
—
AK
Enumeration date
03/23/2006
Last updated
07/08/2007
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