MEDICARE: CHRISTINE BURSAW RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	200095	CO

General Provider Information

NPI Number	:	1912278045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE BURSAW RN

Provider Business Mailing Address
First Line	:	4788 PONDEROSA DR
Second Line	:	#A
City	:	USAF ACADEMY
State	:	CO
Zip	:	80840-1232
Country	:	US
Telephone Number	:	719-578-3297
Fax Number	:

Provider Business Practice Location Address
First Line	:	1675 GARDEN OF THE GODS RD
Second Line	:	STE 2044
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-9444
Country	:	US
Telephone Number	:	719-578-3297
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2012
Last Update Date	:	01/20/2012

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