Provider Demographics
NPI:1962955062
Name:BOURQUE, MELISSA NICOLE (APRN)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:NICOLE
Last Name:BOURQUE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:NICOLE
Other - Last Name:LA BRANCHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:240 SOUTH MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:WOLFEBORO
Mailing Address - State:NH
Mailing Address - Zip Code:03894
Mailing Address - Country:US
Mailing Address - Phone:603-569-7500
Mailing Address - Fax:603-515-2031
Practice Address - Street 1:984 WHITTIER HWY
Practice Address - Street 2:MOULTONBOROUGH FAMILY MEDICINE
Practice Address - City:MOULTONBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03254
Practice Address - Country:US
Practice Address - Phone:603-476-2216
Practice Address - Fax:603-476-5396
Is Sole Proprietor?:No
Enumeration Date:2016-07-26
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH059980-23363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health