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General NPI Number Information
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NPI Number | 1144732579
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Entity Type | Individual
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Provider Name | BETH ALYSON BOURQUIN CNP
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Gender | Female
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Dates
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Enumeration Date | 10/25/2017
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Last Update Date | 09/26/2025
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Provider Practice Location Address
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Address Line | 1 CHILDRENS PLZ
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City | DAYTON
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State | OH
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Zip | 45404-1873
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Country | US
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Telephone | 937-641-5444
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 933432
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City | CLEVELAND
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State | OH
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Zip | 44193-0039
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Country | US
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Telephone | 937-641-5871
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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 | 363LP0222X
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Taxonomy Name | Critical Care Pediatric Nurse Practitioner
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License Number | 021714
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | APRN.CNP.021714
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License Number State | OH
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