Individual provider · Type 1 NPI

Shady Bourham

Licensed Practical Nurse · Brooklyn, NY

NPI number 1316480643 Active

Practice location

6321 New Utrecht Ave
Brooklyn, NY 11219-5425

Call (212) 687-7464 Map

Fax (212) 257-7016

Mailing address

250 Central Ave, APT215-B
Newark, NJ 07103-4201

Specialties and licenses

TaxonomyCodeLicense
Licensed Practical Nurse Primary 164W00000X327253 (NY)

Licensed Practical Nurse: An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states.

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About NPI 1316480643

Shady Bourham's National Provider Identifier is 1316480643, issued on Nov 18, 2016. The primary taxonomy on file is Licensed Practical Nurse (164W00000X), and the practice location is in Brooklyn, NY. The record was last updated on Nov 18, 2016.