Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 118599 | CO |
NPI | 1669459814 |
---|---|
Provider Name | Ms. Ginia Y Burdick |
First Address | Colorado Springs, CO 80910-3190 |
Second Address | Colorado Springs, CO 80910-3127 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2005 |
Last Update Date | 07/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
84288345 | (05) | CO |
Q03334 | (02) | CO |