Provider Demographics
NPI:1154532141
Name:BOURGUIGNON, ANNE L (ANP-BC)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:L
Last Name:BOURGUIGNON
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80223-1108
Mailing Address - Country:US
Mailing Address - Phone:303-501-9515
Mailing Address - Fax:
Practice Address - Street 1:352 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80223-1108
Practice Address - Country:US
Practice Address - Phone:303-501-9515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO177645363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health