Provider Demographics
NPI:1316533276
Name:BOURSIQUOT, DEANNA LAVERNE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:LAVERNE
Last Name:BOURSIQUOT
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:LAVERNE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20 HOSPITAL OVAL W.
Mailing Address - Street 2:CEDARWOOD HALL, 2ND FLOOR
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595-1571
Mailing Address - Country:US
Mailing Address - Phone:914-493-8170
Mailing Address - Fax:
Practice Address - Street 1:20 HOSPITAL OVAL W.
Practice Address - Street 2:CEDARWOOD HALL, 2ND FLOOR
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1571
Practice Address - Country:US
Practice Address - Phone:914-493-8170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-15
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY346746363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily