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General NPI Number Information
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NPI Number | 1407269400
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Entity Type | Individual
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Provider Name | REBECCA BOURGEOIS FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 06/06/2014
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 1617 N JAMES ST STE 600
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City | ROME
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State | NY
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Zip | 13440-2848
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Country | US
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Telephone | 315-362-6355
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Fax | 315-362-6356
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Provider Business Mailing Address
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Address Line | 1617 N JAMES ST STE 600
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City | ROME
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State | NY
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Zip | 13440-2848
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Country | US
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Telephone | 315-362-6355
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Fax | 315-362-6356
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 346512
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | F346512-01
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License Number State | NY
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