Mary Bourbon

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R089401 Issued in MD

Practice address

1600 S. Cain Highway
Suite 401
Glen Burnie, MD 21061

Phone

(410) 768-5050

NPI assigned

Jun 10, 2015

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Advanced Pain Management Specialists, LLC

  • Clinical Medical Laboratory
  • Owings Mills, MD
  • NPI 1316315740
  NPD (past)
• Corsica River Mental Health Services, Inc.

  • Adult Mental Health Clinic/Center
  • Centreville, MD
  • NPI 1396077749
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1433894400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464825600000",
    "number": "1023499548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 S. CAIN HIGHWAY",
            "address_2": "SUITE 401",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "21061",
            "telephone_number": "410-768-5050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 S. CAIN HIGHWAY",
            "address_2": "SUITE 401",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "21061",
            "telephone_number": "410-768-5050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURBON",
        "first_name": "MARY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-10",
        "last_updated": "2016-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "R089401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jonathan Booth
• Michael Booth
• Robert Walker Borgmann
• Cynthia Page Bouchard
• Brittney Boulden
• Cynthia Ann Bourret, PHD
• Amy Raquel Bowers, CSC-AD
• Shannon Bowie, OTR/L
• Michael T Bowling
• Meghan Boyd, LCSW-C

• Family Nurse Practitioner in Glen Burnie, MD
• Providers in Glen Burnie, MD by specialty
• Family Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.