Provider Demographics
NPI:1861731424
Name:BOURGOIN, KEELA A (CD, PPD, CBE, CMT)
Entity type:Individual
Prefix:MS
First Name:KEELA
Middle Name:A
Last Name:BOURGOIN
Suffix:
Gender:F
Credentials:CD, PPD, CBE, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8265
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01971-8265
Mailing Address - Country:US
Mailing Address - Phone:914-433-5003
Mailing Address - Fax:
Practice Address - Street 1:14 LEMON ST
Practice Address - Street 2:UNIT 1
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-3941
Practice Address - Country:US
Practice Address - Phone:914-433-5003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-01
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174H00000XOther Service ProvidersHealth Educator