Healthcare Provider Details

I. General information

NPI: 1447807383
Provider Name (Legal Business Name): ASHLEY E. BOURASSA APRN, NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY E. PAULSEN

II. Dates (important events)

Enumeration Date: 08/26/2019
Last Update Date: 09/09/2022
Certification Date: 09/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 FARMINGTON AVE
FARMINGTON CT
06030-0001
US

IV. Provider business mailing address

16 SAM ST
ENFIELD CT
06082-5758
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-2397
  • Fax:
Mailing address:
  • Phone: 508-367-0684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number8440
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: