Healthcare Provider Details

I. General information

NPI: 1174900286
Provider Name (Legal Business Name): JOSEPH HENDRICKS BURDS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 MERCY DR
DUBUQUE IA
52001-7320
US

IV. Provider business mailing address

1311 N GRANDVIEW AVE
DUBUQUE IA
52001-5868
US

V. Phone/Fax

Practice location:
  • Phone: 563-589-8000
  • Fax:
Mailing address:
  • Phone: 563-581-1316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number118823
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberD118823
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: