Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 95466 | OK |
NPI | 1063815546 |
---|---|
Provider Name | Bart Burdick |
First Address | Oklahoma City, OK 73132-3316 |
Second Address | Oklahoma City, OK 73116-1578 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2014 |
Last Update Date | 29/03/2021 |