Healthcare Provider Details

I. General information

NPI: 1578612867
Provider Name (Legal Business Name): LISA BOURCIER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 03/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16440 GRATIOT RD
HEMLOCK MI
48626-8655
US

IV. Provider business mailing address

1447 N HARRISON ST
SAGINAW MI
48602-4727
US

V. Phone/Fax

Practice location:
  • Phone: 989-583-0660
  • Fax: 989-583-0669
Mailing address:
  • Phone: 989-583-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704147440
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: