Provider Demographics
NPI:1497548812
Name:BURDA, SUSAN MICHELLE (RN)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MICHELLE
Last Name:BURDA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SUSAN BURDA
Mailing Address - Street 2:17030 293RD STREET
Mailing Address - City:LONG GROVE
Mailing Address - State:IA
Mailing Address - Zip Code:52756
Mailing Address - Country:US
Mailing Address - Phone:563-209-0784
Mailing Address - Fax:
Practice Address - Street 1:MERCYONE GENESIS
Practice Address - Street 2:1227 EAST RUSHOLME STREET
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803
Practice Address - Country:US
Practice Address - Phone:563-421-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA129673163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical