Healthcare Provider Details

I. General information

NPI: 1124094941
Provider Name (Legal Business Name): VIRGINIA DAWN BURDINE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 MERCY DR
DUBUQUE IA
52001-7320
US

IV. Provider business mailing address

10715 EAGLE RIDGE CT
PEOSTA IA
52068-7005
US

V. Phone/Fax

Practice location:
  • Phone: 563-589-8619
  • Fax:
Mailing address:
  • Phone: 33-807-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License NumberDR.0039152
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number22704
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD-47946
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: