MEDICARE: MELANIE R BOURKE APRN, PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	10003322	OR
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	61385949	WA
3	163W00000X	Registered Nurse	R 218003-8	MN
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	5275	MN
5	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	16286-33	WI
6	163W00000X	Registered Nurse	95351724	CA
7	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	95027422	CA

General Provider Information

NPI Number	:	1588051213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELANIE R BOURKE APRN, PMHNP

Provider Business Mailing Address
First Line	:	3218 N BOOTH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-2136
Country	:	US
Telephone Number	:	763-670-4887
Fax Number	:

Provider Business Practice Location Address
First Line	:	975 SE SANDY BLVD STE 230
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97214-1399
Country	:	US
Telephone Number	:	503-379-1902
Fax Number	:	503-334-1617

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2015
Last Update Date	:	03/02/2026

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