Healthcare Provider Details

I. General information

NPI: 1275683146
Provider Name (Legal Business Name): SUE ANN BARDSLEY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 11/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

528 E MARKET ST
GEORGETOWN DE
19947-2255
US

IV. Provider business mailing address

528 E MARKET ST
GEORGETOWN DE
19947-2255
US

V. Phone/Fax

Practice location:
  • Phone: 302-856-4700
  • Fax: 302-856-4705
Mailing address:
  • Phone: 302-856-4700
  • Fax: 302-856-4705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberLE-0000165
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: