Healthcare Provider Details

I. General information

NPI: 1144306937
Provider Name (Legal Business Name): MARY BERNADETTE BOURNE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. MARY BERNADETTE LYNCH

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 CHALKSTONE AVE
PROVIDENCE RI
02908-4734
US

IV. Provider business mailing address

28 FREEBORN ST
NEWPORT RI
02840-1822
US

V. Phone/Fax

Practice location:
  • Phone: 401-273-7100
  • Fax: 401-457-3371
Mailing address:
  • Phone: 401-849-1722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN29721
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: