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NPI Code Detail

MEDICARE: MADISON BOURQUE FNP-C

MEDICARE: MADISON BOURQUE FNP-C
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 Practitioner211170LA

General Provider Information

NPI Number : 1538965447
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADISON BOURQUE FNP-C
Provider Business Mailing Address
First Line : 600 CYPRESS ST
Second Line :
City : SULPHUR
State : LA
Zip : 70663-5052
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 600 CYPRESS ST
Second Line :
City : SULPHUR
State : LA
Zip : 70663-5052
Country : US
Telephone Number : 337-527-6371
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2025
Last Update Date : 01/20/2026

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Directions to “ MADISON BOURQUE FNP-C” Practice Location

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