| Peter Bourque Np | |
|
1650 Sycamore Ave Bohemia NY 11716-1738 | |
| (631) 317-1024 | |
| Not Available |
| Full Name | Peter Bourque Np |
|---|---|
| Speciality | Nurse Practitioner - Psychiatric/mental Health |
| Location | 1650 Sycamore Ave, Bohemia, New York |
| Authorized Official Name and Position | Peter Ralph Bourque (OWNER) |
| Authorized Official Contact | 8609606675 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Peter Bourque Np 2813 Mcdougall Dr Conway SC 29526-4153 Ph: (860) 960-6675 | Peter Bourque Np 1650 Sycamore Ave Bohemia NY 11716-1738 Ph: (631) 317-1024 |
| NPI Number | 1629810585 |
|---|---|
| Provider Enumeration Date | 06/11/2024 |
| Last Update Date | 10/03/2024 |
| Certification Date | 10/03/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629810585 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | (* (Not Available)) | Primary |
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