Healthcare Provider Details

I. General information

NPI: 1497935043
Provider Name (Legal Business Name): DONNA MICHELLE BURGE PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 12/05/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 STURGIS ROAD
TWENTYNINE PALMS CA
97228
US

IV. Provider business mailing address

1145 STURGIS ROAD
TWENTYNINE PALMS CA
92278-8275
US

V. Phone/Fax

Practice location:
  • Phone: 760-830-2117
  • Fax:
Mailing address:
  • Phone: 760-830-2117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN1033950
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code364SM0705X
TaxonomyMedical-Surgical Clinical Nurse Specialist
License NumberRN1033950
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: