Provider Demographics
NPI:1487196895
Name:BOURDEAUX, ERIKA LEIGH (DNP, RN, CPNP-PC)
Entity Type:Individual
Prefix:DR
First Name:ERIKA
Middle Name:LEIGH
Last Name:BOURDEAUX
Suffix:
Gender:F
Credentials:DNP, RN, CPNP-PC
Other - Prefix:
Other - First Name:ERIKA
Other - Middle Name:LEIGH
Other - Last Name:KIPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2825 PRAIRIE AVE
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-1844
Mailing Address - Country:US
Mailing Address - Phone:608-363-5500
Mailing Address - Fax:
Practice Address - Street 1:2825 PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-1844
Practice Address - Country:US
Practice Address - Phone:608-363-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7358-33363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics