Bourque, Gloria G

Bourque, Gloria G is an individual health care provider with primary practice located at 1919 Lathrop St Ste 220, Fairbanks AK 99701. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, which is considered as her primary health care specialty. Bourque, Gloria G can be contacted via phone (907) 452-1739.

Contact Information

Primary practice address
1919 Lathrop St Ste 220 Fairbanks AK 99701
Phone: (907) 452-1739
Fax: (907) 452-2384
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 545 Alaska

Profile Details

NPI number 1750341053
LBN Legal business name Bourque, Gloria G
Credentials Adult Nurse Practitioner (ANP)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 23rd, 2006
Last updated Jul 8th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1750341053 NPPES
Alaska MEDICAID NP0545
Alaska MEDICAID GR0221

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