MARY BOURBON (NPI# 1023499548) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023499548 |
| Entity Type | Individual |
| Full Name | MARY BOURBON |
| Practice Address |
1600 S. Cain Highway Suite 401 Glen Burnie MD 21061 |
| Practice Telephone | 4107685050 |
| Mailing Telephone | 4107685050 |
| Enumeration Date | 2015-06-10 |
| Last Update Date | 2016-06-02 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
R089401 | MD | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1600 S. CAIN HIGHWAY SUITE 401 |
| City | GLEN BURNIE |
| State | MD |
| Zip Code | 21061 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255814422 | Lotus Behavioral Health and Rehabilitation Services Inc. | Behavior Technician | 6426 Harrison Square, Glen Burnie, MD 21061 | 2018-09-12 |
| 1942795315 | Tina Brown | Behavior Technician | Rise for Autism, 510 Mccormick Drive, Ste. U-w, Glen Burnie, MD 21061 | 2018-06-27 |
| 1205351905 | Digna Emerita Sanchez De Vasquez | Specialist/Technologist, Other | 201 Fernglen Ave, Glen Burnie, MD 21061 | 2017-08-03 |
| 1255780300 | Rachel Cutts | Physical Therapist | 7711 Quarterfield Rd Ste C2, Glen Burnie, MD 21061 | 2016-06-09 |
| 1295181170 | Gaudenzia, Inc. | Counselor | 5 Crain Highway North - Rear Suite Entrance, Glen Burnie, MD 21061 | 2016-05-10 |
| 1972997724 | Robert Oladeinde | Physician Assistant | 6934 Aviation Blvd Suite B, Glen Burnie, MD 21061 | 2015-03-18 |
| 1205248069 | Cathy Qing He | Anesthesiology | 1600 Crain Hwy S Ste 301, Glen Burnie, MD 21061 | 2014-05-28 |
| 1477974764 | Shannon Holder | Nurse Practitioner | 1916 Crain Hwy S Ste 2, Glen Burnie, MD 21061 | 2014-01-03 |
| 1629404207 | Marla Ann Muha | Physician Assistant | 301 Hospital Dr # 803, Glen Burnie, MD 21061 | 2013-09-16 |
| 1902142839 | Behavioral Healthcare of Maryland | Clinic/Center | 1405 Madison Park Drive Suite 1b, Glen Burnie, MD 21061 | 2012-12-21 |
| Find all providers in zip 21061 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942827258 | Grace Oluwatoyin Efunbajo | Nurse Practitioner | 424 Poinsettia Pl, Glen Burnie, MD 21060-6353 | 2020-07-02 |
| 1508493180 | Md Matt LLC | Nurse Practitioner | 12 Crain Hwy N, Glen Burnie, MD 21061-3565 | 2020-03-24 |
| 1073087037 | Nicholas Adam Wolf | Nurse Practitioner | 1420 Gordon Dr, Glen Burnie, MD 21061-2845 | 2019-01-14 |
| 1275009441 | Anna Kennedy | Nurse Practitioner | 331 Oak Manor Dr Ste 203, Glen Burnie, MD 21061-5555 | 2018-10-16 |
| 1902371321 | Titilayo Akinsola | Nurse Practitioner | 1600 Crain Hwy S Ste 201, Glen Burnie, MD 21061-6438 | 2018-10-11 |
| 1245770189 | Sheri Dean | Nurse Practitioner | 7702 Gaston Pl, Glen Burnie, MD 21060-8623 | 2017-02-26 |
| 1760920144 | Nashae Handy | Nurse Practitioner | 705 Bunch Ave, Glen Burnie, MD 21060-6940 | 2017-02-07 |
| 1710429394 | Jennifer Sherwood | Nurse Practitioner | 7701 Quarterfield Rd Ste A, Glen Burnie, MD 21061-4427 | 2016-11-14 |
| 1013363670 | Jesse Okonigbo | Nurse Practitioner | 116 Warwickshire Ln, Apt E, Glen Burnie, MD 21061-1727 | 2016-05-12 |
| 1295131662 | Jornayra Powell-gross | Nurse Practitioner | 7678 Quarterfield Rd Ste 201, Glen Burnie, MD 21061-7071 | 2014-11-13 |
| Find all providers in GLEN BURNIE | ||||
| City | GLEN BURNIE |
| Zip Code | 21061 |
Please comment or provide details below to improve the information on MARY BOURBON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.