Doctor Name: | THERESA A BURDICK |
NPI Number: | 1396882312 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | F331500 |
Business Practice Address: | 40 Jon Barrett Rd Patterson, NY - 125632164 |
Business Phone Number: | 8458789078 |
Business Fax Number: | 8458786139 |
Mailing Address: | 19 Ailish Ln, BREWSTER |
State: | NY |
Postal Code: | 105092164 |
Phone Number: | 8452788033 |
Fax Number: | |
NPI Enumeration Date: | 01/31/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | F331500 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |