Provider Demographics
NPI:1437512563
Name:BOURNE, CLAIRE ANN (NP)
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:ANN
Last Name:BOURNE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CLAIRE
Other - Middle Name:
Other - Last Name:REIDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE BOX MED
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-276-6401
Mailing Address - Fax:585-273-1058
Practice Address - Street 1:601 ELMWOOD AVE.
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-276-6401
Practice Address - Fax:585-273-1058
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307304363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04385264Medicaid
NY04385264Medicaid
NYJ400300491-GRP70008AMedicare PIN