Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 95002759 | CA |
NPI | 1023493889 |
---|---|
Provider Name | Marina Bourke |
First Address | Mission Hills, CA 91346-9602 |
Second Address | Mission Hills, CA 91345-1113 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2015 |
Last Update Date | 14/02/2019 |