Healthcare Provider Details

I. General information

NPI: 1952640948
Provider Name (Legal Business Name): ERIKA BOURNE R.N., C.M.T.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2013
Last Update Date: 02/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 ARLINGTON ST SUITE 1
WATERTOWN MA
02472-2090
US

IV. Provider business mailing address

203 ARLINGTON ST SUITE 1
WATERTOWN MA
02472-2090
US

V. Phone/Fax

Practice location:
  • Phone: 781-894-9430
  • Fax:
Mailing address:
  • Phone: 781-894-9430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License NumberRN234770
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: