Provider Demographics
NPI:1467164202
Name:BLUDORN, SUSAN KAYE (RTA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:KAYE
Last Name:BLUDORN
Suffix:
Gender:F
Credentials:RTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE VETERAN DRIVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-1679
Mailing Address - Country:US
Mailing Address - Phone:612-467-7200
Mailing Address - Fax:
Practice Address - Street 1:ONE VETERAN DRIVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-1679
Practice Address - Country:US
Practice Address - Phone:612-467-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-22
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreational Therapist Assistant