Individual
KRISTEN BOURGON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSN, AGPCNP-BC
Contact information
Practice address
21650 W 11 MILE RD STE 202, SOUTHFIELD, MI 48076-3777
(248) 327-6196
(248) 327-6356
Mailing address
20075 NORTHVILLE PLACE DR, NORTHVILLE, MI 48167-2984
(248) 672-2271
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
4704277091
MI
363LF0000X
Family Nurse Practitioner
Primary
4704277091
MI
363LG0600X
Gerontology Nurse Practitioner
4704277091
MI
363LP2300X
Primary Care Nurse Practitioner
4704277091
MI
Other
Enumeration date
01/30/2017
Last updated
03/09/2021
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