Healthcare Provider Details

I. General information

NPI: 1477666485
Provider Name (Legal Business Name): JENNIFER M BURSTAIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 09/13/2021
Certification Date: 08/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 1ST AVE SE
CEDAR RAPIDS IA
52402-5320
US

IV. Provider business mailing address

999 164TH AVE NE
BELLEVUE WA
98008-3518
US

V. Phone/Fax

Practice location:
  • Phone: 319-366-1503
  • Fax: 319-366-6976
Mailing address:
  • Phone: 425-586-2338
  • Fax: 425-957-0351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number33047
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: