Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | MD00016175 | WA |
NPI | 1174673214 |
---|---|
Provider Name | Dr. Theresa Agnes Burdick |
First Address | Seattle, WA 98122-4328 |
Second Address | Seattle, WA 98122-4328 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1718600 | (05) | WA |
A04176 | (02) | WA |