Provider Demographics
NPI:1851646541
Name:BOURNE, CLAUDIANUS H (FNP)
Entity type:Individual
Prefix:
First Name:CLAUDIANUS
Middle Name:H
Last Name:BOURNE
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1081
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12181-1081
Mailing Address - Country:US
Mailing Address - Phone:518-791-9607
Mailing Address - Fax:
Practice Address - Street 1:407 ALBANY SHAKER RD STE 100
Practice Address - Street 2:
Practice Address - City:LOUDONVILLE
Practice Address - State:NY
Practice Address - Zip Code:12211-1962
Practice Address - Country:US
Practice Address - Phone:518-435-1300
Practice Address - Fax:518-435-1397
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF337303363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02995513Medicaid
NY331833Medicare Oscar/Certification
NY02995513Medicaid
NY02995513Medicaid