| NPI | 1194019794 |
|---|---|
| Former Name | KATIE ELIZABETH BOURQUE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 206909) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125-059895) |
| Enumeration Date | 2011-06-01 |
| Last Update Date | 2024-05-08 |