Healthcare Provider Details

I. General information

NPI: 1568578276
Provider Name (Legal Business Name): TAMARA M BURDI CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 01/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E. HAMPDEN AVE #120
ENGLEWOOD CO
80113
US

IV. Provider business mailing address

701 E. HAMPDEN AVE #120
ENGLEWOOD CO
80113
US

V. Phone/Fax

Practice location:
  • Phone: 303-781-5299
  • Fax: 303-781-5809
Mailing address:
  • Phone: 303-781-5299
  • Fax: 303-781-5809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number127056
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: