Provider Demographics
NPI:1104180850
Name:TARDIF, SUE ELLEN (BSN)
Entity type:Individual
Prefix:MRS
First Name:SUE
Middle Name:ELLEN
Last Name:TARDIF
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 SILVER SPUR RD
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-1208
Mailing Address - Country:US
Mailing Address - Phone:307-421-0396
Mailing Address - Fax:
Practice Address - Street 1:1812 SILVER SPUR RD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-1208
Practice Address - Country:US
Practice Address - Phone:307-421-0396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY19148163WH1000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WH1000XNursing Service ProvidersRegistered NurseHospice