Provider Demographics
NPI:1013946508
Name:BOURDON, SUSAN (RN, MSN, CS)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:BOURDON
Suffix:
Gender:F
Credentials:RN, MSN, CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 MURRAY AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-2352
Mailing Address - Country:US
Mailing Address - Phone:412-421-6770
Mailing Address - Fax:412-421-6596
Practice Address - Street 1:2345 MURRAY AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15217-2352
Practice Address - Country:US
Practice Address - Phone:412-421-6770
Practice Address - Fax:412-421-6596
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN321656L163WP0809X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100730154Medicaid
PA100730154Medicaid
P58620Medicare UPIN