Provider Demographics
NPI:1467546820
Name:BOURDIN, SHERRY LOUISE (NP)
Entity Type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:LOUISE
Last Name:BOURDIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:SHERRY
Other - Middle Name:LOUISE
Other - Last Name:BOURDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1830 SW DICKINSON LN
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-9602
Mailing Address - Country:US
Mailing Address - Phone:503-246-8095
Mailing Address - Fax:
Practice Address - Street 1:9800 SE SUNNYSIDE RD
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-9750
Practice Address - Country:US
Practice Address - Phone:503-653-6440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR076036950N3363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health