Provider Demographics
NPI:1326365446
Name:DUBOURDIEU, KATHLEEN MARIE (RNP, MN)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:MARIE
Last Name:DUBOURDIEU
Suffix:
Gender:F
Credentials:RNP, MN
Other - Prefix:MRS
Other - First Name:KATHY
Other - Middle Name:MARIE
Other - Last Name:DUBOURDIEU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RNP, MN
Mailing Address - Street 1:500 SUPERIOR AVE
Mailing Address - Street 2:STE 310
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3609
Mailing Address - Country:US
Mailing Address - Phone:949-644-2722
Mailing Address - Fax:949-760-5438
Practice Address - Street 1:2192 MARTIN STE 110
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-1484
Practice Address - Country:US
Practice Address - Phone:949-955-0072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA429686363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology