Individual
MEREDITH EALISE BOURQUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
360 DUNCAN DR, PROVIDENCE, RI 02906-7003
(401) 383-5150
Mailing address
530 N MAIN ST, PROVIDENCE, RI 02904-5762
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
56383
RI
163W00000X
Registered Nurse
Primary
RN56383
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
163W00000X
—
RI
Enumeration date
06/02/2017
Last updated
06/02/2017
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