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NPI Code Detail

MEDICARE: RENEE LILLIAN BOURGEOIS

MEDICARE: RENEE LILLIAN BOURGEOIS
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
1363LF0000XFamily Nurse PractitionerAPRN001873NV

General Provider Information

NPI Number : 1457743429
Entity Type Code : Individual
Provider Name (Legal Business Name) : RENEE LILLIAN BOURGEOIS
Provider Business Mailing Address
First Line : 8105 MUSTANG HILL CT
Second Line :
City : LAS VEGAS
State : NV
Zip : 89131-5505
Country : US
Telephone Number : 702-641-9415
Fax Number :
Provider Business Practice Location Address
First Line : 7285 S DURANGO DR
Second Line :
City : LAS VEGAS
State : NV
Zip : 89113-2098
Country : US
Telephone Number : 702-407-2933
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/26/2015
Last Update Date : 02/26/2015

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Directions to “ RENEE LILLIAN BOURGEOIS ” Practice Location

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