Healthcare Provider Details

I. General information

NPI: 1811504749
Provider Name (Legal Business Name): MAGGIE MCNEAL BURTCH RN, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 BUCHANAN RD STE C10
ANTIOCH CA
94509-4226
US

IV. Provider business mailing address

1307 MAGNOLIA ST
OAKLAND CA
94607-2224
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-1000
  • Fax:
Mailing address:
  • Phone: 614-746-2905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95173896
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number95015809
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: