Molly Laura Bourgault, NP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

16810 Issued in CA

Practice address

19537 Sager Loop
Bend, OR 97702

Phone

(858) 401-3314

NPI assigned

Apr 14, 2007

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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

{
    "created_epoch": "1176508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1517184000000",
    "number": "1326263500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19537 SAGER LOOP",
            "city": "BEND",
            "state": "OR",
            "postal_code": "97702",
            "telephone_number": "858-401-3314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19537 SAGER LOOP",
            "city": "BEND",
            "state": "OR",
            "postal_code": "97702",
            "telephone_number": "858-401-3314"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1075 Camino Del Rio S",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921083538",
            "country_code": "US",
            "telephone_number": "619-881-4500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOURGAULT",
        "first_name": "MOLLY",
        "middle_name": "LAURA",
        "name_prefix": "Ms.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-14",
        "last_updated": "2018-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "CA",
            "license": "16810",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katrina Garcia Boswell, DOULA
• Robine Bots, M.S.
• Amy Danielle Bottaro, AUD
• Victoria C Boudinot, M.S.
• Shelby Kathryn Boudreau
• Kevin J. Bourlai, PT
• Bobbi Alison Bourland
• Ileana Bourland, MSOM LICAC
• Daniel Joseph Bourque, D.C.
• Elizabeth Philbin Bouvier, MA

• Adult Health Nurse Practitioner in Bend, OR
• Providers in Bend, OR by specialty
• Adult Health Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2018; 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.