Provider Demographics
NPI:1407269400
Name:BOURGEOIS, REBECCA (FNP-BC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:BOURGEOIS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 N JAMES ST STE 600
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-2848
Mailing Address - Country:US
Mailing Address - Phone:315-362-6355
Mailing Address - Fax:315-362-6356
Practice Address - Street 1:1617 N JAMES ST STE 600
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-2848
Practice Address - Country:US
Practice Address - Phone:315-362-6355
Practice Address - Fax:315-362-6356
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-06
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY346512363LF0000X
NYF346512-01363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health