Healthcare Provider Details

I. General information

NPI: 1851646541
Provider Name (Legal Business Name): CLAUDIANUS H BOURNE FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2012
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 ALBANY SHAKER RD STE 100
LOUDONVILLE NY
12211-1962
US

IV. Provider business mailing address

PO BOX 1081
TROY NY
12181-1081
US

V. Phone/Fax

Practice location:
  • Phone: 518-435-1300
  • Fax: 518-435-1397
Mailing address:
  • Phone: 518-791-9607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF337303
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: