=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790580835
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | OLIVIA FLORES-BOURGEOIS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2025
-----------------------------------------------------
Last Update Date | 03/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7 TECHNOLOGY DR STE 102
-----------------------------------------------------
City | NORTH CHELMSFORD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01863-2441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-677-6354
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19 HIGH VIEW DR
-----------------------------------------------------
City | BROOKLINE
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03033-2146
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | RN2357642
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------