Healthcare Provider Details

I. General information

NPI: 1013946508
Provider Name (Legal Business Name): SUSAN BOURDON RN, MSN, CS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 MURRAY AVE SUITE 200
PITTSBURGH PA
15217-2352
US

IV. Provider business mailing address

2345 MURRAY AVE SUITE 200
PITTSBURGH PA
15217-2352
US

V. Phone/Fax

Practice location:
  • Phone: 412-421-6770
  • Fax: 412-421-6596
Mailing address:
  • Phone: 412-421-6770
  • Fax: 412-421-6596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN321656L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberRN321656L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: