Provider Demographics
NPI:1124631643
Name:BOURDO-BROWN, HARLIE SUE (PA-C)
Entity type:Individual
Prefix:
First Name:HARLIE
Middle Name:SUE
Last Name:BOURDO-BROWN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:HARLIE
Other - Middle Name:SUE
Other - Last Name:BOURDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12040 NE 128TH ST # MS -100
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3013
Mailing Address - Country:US
Mailing Address - Phone:425-899-1854
Mailing Address - Fax:425-899-4490
Practice Address - Street 1:12303 NE 130TH LN STE 420
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3042
Practice Address - Country:US
Practice Address - Phone:425-899-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA.61227695363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant