Healthcare Provider Details

I. General information

NPI: 1134498884
Provider Name (Legal Business Name): JAN BURCH PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2011
Last Update Date: 11/17/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 ALLEN ST
MARTINEZ CA
94553
US

IV. Provider business mailing address

25 ALLEN ST
MARTINEZ CA
94553
US

V. Phone/Fax

Practice location:
  • Phone: 925-951-3678
  • Fax:
Mailing address:
  • Phone:
  • Fax: 310-221-6350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95079711
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95023725
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: