Jeanne M Bourget

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

AP30001711 Issued in WA

Practice address

4410 106TH St SW
Mukilteo, WA 98275-4700

Phone

(425) 388-6004

NPI assigned

Nov 9, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354752000000",
    "number": "1093885436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5127",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982065127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4410 106TH ST SW",
            "city": "MUKILTEO",
            "state": "WA",
            "postal_code": "982754700",
            "telephone_number": "425-388-6004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURGET",
        "first_name": "JEANNE",
        "middle_name": "M",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-09",
        "last_updated": "2012-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WA",
            "license": "AP30001711",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9602152",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "AP30001711",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christoper J Bibby, MD
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• Quincy Bolden
• Agnes Ayap Borjal, PT
• Amy Marie Braden, LMP
• Danielle H Bradshaw, LMHC, LCPC
• Peter Mathias Britton, D.C.
• Julie K Brogren, MD
• Cassandra Brown, CNA

• Nurse Practitioner in Mukilteo, WA
• Providers in Mukilteo, WA by specialty
• Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2012; 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.