CHANELL RAVEN BOURNE MD
NPI 1356089775
Student in an Organized Health Care Education/Training Program in Providence, RI
About Chanell Raven Bourne Md NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
CHANELL RAVEN BOURNE MD (NPI 1356089775) is an individual student in an organized health care education/training program in Providence, Rhode Island, licensed in Rhode Island (LP05536) and active in the NPI registry since May 2022. She is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Chanell Raven Bourne Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
PROVIDENCE, RI 02903
PROVIDENCE, RI 02903
PROVIDENCE, RI 02903
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Chanell Bourne's NPI number?
The NPI number for Chanell Bourne is 1356089775. It was assigned to this individual provider in the NPPES registry on May 25, 2022.
Where is Chanell Bourne located?
Chanell Bourne practices at 593 Eddy St, Providence, RI 02903. The listed phone number is (401) 444-5180.
What is Chanell Bourne's specialty?
The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.
Is Chanell Bourne enrolled in Medicare?
Yes. Chanell Bourne is registered in the Medicare PECOS enrollment system.
When was this NPI record last updated?
The NPPES record for Chanell Bourne was last updated on May 25, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Chanell Raven Bourne, MD · NPI 1356089775
Student in an Organized Health Care Education/Training Program provider in Providence, Rhode Island. Individual provider, active in the CMS NPPES registry since May 25, 2022.
## Identity
- **NPI:** 1356089775 (Entity type: Individual)
- **Enumerated:** May 25, 2022
- **Primary specialty:** Student in an Organized Health Care Education/Training Program · taxonomy 390200000X
- **State license:** LP05536 (Rhode Island)
- **Sole proprietor:** No
## Practice location
- **Address:** 593 EDDY ST, Providence, RI 02903-4923
- **Phone:** (401) 444-5180
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
## Record status
- **NPPES last updated:** May 25, 2022
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Source: [NPI Profile](https://npiprofile.com/npi/1356089775) · Data from the CMS NPPES public registry.