Provider Demographics
NPI:1184111486
Name:BOURGUET VALENTE, ADRIENNE NICOLE (CRNP)
Entity type:Individual
Prefix:MISS
First Name:ADRIENNE
Middle Name:NICOLE
Last Name:BOURGUET VALENTE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ADRIENNE
Other - Middle Name:NICOLE
Other - Last Name:BOURGUET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:3100 MOUNTAIN RD
Mailing Address - Street 2:PEDIATRIC PLACE
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21222
Mailing Address - Country:US
Mailing Address - Phone:410-360-4446
Mailing Address - Fax:410-360-4449
Practice Address - Street 1:3100 MOUNTAIN RD
Practice Address - Street 2:PEDIATRIC PLACE
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21222
Practice Address - Country:US
Practice Address - Phone:410-360-4446
Practice Address - Fax:410-360-4449
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR224364363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics