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General NPI Number Information
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NPI Number | 1124027263
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Entity Type | Individual
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Provider Name | MICHELLE L BOURNE PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/20/2005
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Last Update Date | 02/12/2014
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Provider Practice Location Address
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Address Line | 2080 HWY 9 WEST
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City | NORMAN
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State | OK
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Zip | 73072
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Country | US
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Telephone | 405-322-6800
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Fax |
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Provider Business Mailing Address
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Address Line | 4008 WOOD CASTLE ST
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City | NORMAN
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State | OK
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Zip | 73072-1795
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Country | US
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Telephone | 405-919-8490
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1164
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License Number State | OK
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