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General NPI Number Information
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NPI Number | 1568096972
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Entity Type | Individual
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Provider Name | JANNINE DENISE BOURNIAS AGNP
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Gender | Female
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Dates
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Enumeration Date | 02/24/2020
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Last Update Date | 02/25/2020
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Provider Practice Location Address
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Address Line | 100 MEDICAL CENTER WAY
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City | SOMERS POINT
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State | NJ
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Zip | 08244-2300
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Country | US
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Telephone | 609-653-3500
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Fax |
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Provider Business Mailing Address
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Address Line | 33 E STATION RD
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City | OCEAN CITY
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State | NJ
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Zip | 08226-4451
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Country | US
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Telephone | 856-625-3547
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 26NJ00991600
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License Number State | NJ
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