Healthcare Provider Details

I. General information

NPI: 1952536807
Provider Name (Legal Business Name): JAMIE J BOURGEOIS CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAMIE J SPENCER

II. Dates (important events)

Enumeration Date: 05/21/2009
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 WALL ST
MANCHESTER NH
03101-1518
US

IV. Provider business mailing address

2 WALL ST STE 200
MANCHESTER NH
03101-1518
US

V. Phone/Fax

Practice location:
  • Phone: 603-668-4111
  • Fax: 603-622-4134
Mailing address:
  • Phone: 603-668-4111
  • Fax: 603-622-4134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number054241-23
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number054241-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: