Individual
KAITLIN M BOURDEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1255 BROAD ST STE 201A, BLOOMFIELD, NJ 07003-3061
(973) 842-2100
Mailing address
135 BRAKESHOE PL, MAHWAH, NJ 07430-1102
(551) 804-7432
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
25MP00528000
—
Other
Enumeration date
07/12/2019
Last updated
07/18/2019
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