MEDICARE: JENNIFER LEE BOURASSA LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	LN97646	MA

General Provider Information

NPI Number	:	1023718145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LEE BOURASSA LPN

Provider Business Mailing Address
First Line	:	23 STRATHMORE RD
Second Line	:
City	:	DARTMOUTH
State	:	MA
Zip	:	02747-3113
Country	:	US
Telephone Number	:	508-264-7721
Fax Number	:

Provider Business Practice Location Address
First Line	:	23 STRATHMORE RD
Second Line	:
City	:	DARTMOUTH
State	:	MA
Zip	:	02747-3113
Country	:	US
Telephone Number	:	508-264-7721
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2023
Last Update Date	:	03/07/2023

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