1184111486 NPI number — MISS ADRIENNE NICOLE BOURGUET VALENTE CRNP

Table of content: MISS ADRIENNE NICOLE BOURGUET VALENTE CRNP (NPI 1184111486)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184111486 NPI number — MISS ADRIENNE NICOLE BOURGUET VALENTE CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOURGUET VALENTE
Provider First Name:
ADRIENNE
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOURGUET
Provider Other First Name:
ADRIENNE
Provider Other Middle Name:
NICOLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1184111486
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3100 MOUNTAIN RD
Provider Second Line Business Mailing Address:
PEDIATRIC PLACE
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21222
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-360-4446
Provider Business Mailing Address Fax Number:
410-360-4449

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3100 MOUNTAIN RD
Provider Second Line Business Practice Location Address:
PEDIATRIC PLACE
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-360-4446
Provider Business Practice Location Address Fax Number:
410-360-4449
Provider Enumeration Date:
04/23/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0200X , with the licence number:  R224364 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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