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General NPI Number Information
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NPI Number | 1063928406
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Entity Type | Individual
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Provider Name | MESHELE A BOURDEAU RN, BSN
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Gender | Female
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Dates
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Enumeration Date | 12/21/2017
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Last Update Date | 12/21/2017
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Provider Practice Location Address
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Address Line | 133 AVIATION RD
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City | QUEENSBURY
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State | NY
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Zip | 12804-8206
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Country | US
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Telephone | 518-798-0170
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 494
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City | LAKE LUZERNE
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State | NY
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Zip | 12846-0494
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 667131-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 163WS0200X
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Taxonomy Name | School Registered Nurse
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License Number | 667131-1
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License Number State | NY
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