Healthcare Provider Details

I. General information

NPI: 1457471351
Provider Name (Legal Business Name): GARDA M BURGWINKEL R.N
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 ARLINGTON ST
LEOMINSTER MA
01453-2727
US

IV. Provider business mailing address

85 ARLINGTON ST
LEOMINSTER MA
01453-2727
US

V. Phone/Fax

Practice location:
  • Phone: 978-660-5815
  • Fax:
Mailing address:
  • Phone: 978-660-5815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number194655
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: