MEDICARE: ANA GABRIELA BOURNE R.N.

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	163W00000X	Registered Nurse	657829-1	NY
2	363LW0102X	Women's Health Nurse Practitioner	F421132-1	NY

General Provider Information

NPI Number	:	1154663797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANA GABRIELA BOURNE R.N.

Provider Business Mailing Address
First Line	:	295 FLATBUSH AVENUE EXT
Second Line	:	3RD FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11201-3001
Country	:	US
Telephone Number	:	718-522-1144
Fax Number	:

Provider Business Practice Location Address
First Line	:	305 7TH AVE FL 10
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10001-6146
Country	:	US
Telephone Number	:	212-982-8383
Fax Number	:	646-755-8316

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

Provider Enumeration Date	:	03/21/2013
Last Update Date	:	03/19/2019

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