Provider Demographics
NPI:1275683146
Name:BARDSLEY, SUE ANN (APRN)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:ANN
Last Name:BARDSLEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19947-2255
Mailing Address - Country:US
Mailing Address - Phone:302-856-4700
Mailing Address - Fax:302-856-4705
Practice Address - Street 1:528 E MARKET ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:DE
Practice Address - Zip Code:19947-2255
Practice Address - Country:US
Practice Address - Phone:302-856-4700
Practice Address - Fax:302-856-4705
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELE-0000165163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
DELE-0000165OtherSTATE LICENSE
DE020595V39Medicare PIN
DE020595Medicare PIN