1316533276 NPI number — DEANNA LAVERNE BOURSIQUOT NURSE PRACTITIONER

Table of content: DEANNA LAVERNE BOURSIQUOT NURSE PRACTITIONER (NPI 1316533276)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316533276 NPI number — DEANNA LAVERNE BOURSIQUOT NURSE PRACTITIONER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOURSIQUOT
Provider First Name:
DEANNA
Provider Middle Name:
LAVERNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NURSE PRACTITIONER
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SMITH
Provider Other First Name:
DEANNA
Provider Other Middle Name:
LAVERNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1316533276
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/26/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 HOSPITAL OVAL W.
Provider Second Line Business Mailing Address:
CEDARWOOD HALL, 2ND FLOOR
Provider Business Mailing Address City Name:
VALHALLA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10595-1571
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-493-8170
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 HOSPITAL OVAL W.
Provider Second Line Business Practice Location Address:
CEDARWOOD HALL, 2ND FLOOR
Provider Business Practice Location Address City Name:
VALHALLA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10595-1571
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-493-8170
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/15/2020

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: 363LF0000X , with the licence number:  346746 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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