Provider Demographics
NPI:1174948475
Name:BURGOYNE, JACQUELINE MARIE (NP)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:MARIE
Last Name:BURGOYNE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BENTLEY UNIVERSITY HEALTH CENTER
Mailing Address - Street 2:RHODES HALL 175 FOREST STREET
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02452
Mailing Address - Country:US
Mailing Address - Phone:781-891-2222
Mailing Address - Fax:
Practice Address - Street 1:BENTLEY UNIVERSITY HEALTH CENTER
Practice Address - Street 2:RHODES HALL 175 FOREST STREET
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02452-0214
Practice Address - Country:US
Practice Address - Phone:781-891-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-23
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2284440163W00000X, 363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology