Individual provider · NPI-1
Anne Marie Terease Bourbeau
Student in an Organized Health Care Education/Training Program · Santa Fe, NM
NPI number1407591605
StatusActive
Last updated in NPPESMar 28, 2024
Details
- NPI
- 1407591605
- Entity type
- Individual (NPI-1)
- Name
- Anne Marie Terease Bourbeau
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- May 2, 2022
- Certification date
- Mar 28, 2024
- Last updated
- Mar 28, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – | Yes |
| 106S00000X | Behavior Technician | – | – |
Practice location
2055 S Pacheco St Ste 500Santa Fe, NM 87505-3994
Phone 505-702-8112
Mailing address
901 Rio Grande Blvd Nw Ste G252Albuquerque, NM 87104-2050
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