Healthcare Provider Details

I. General information

NPI: 1275913626
Provider Name (Legal Business Name): JACKIE BURGESS MIDWIFERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2015
Last Update Date: 06/17/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7693 S. VIRGINIA ST
RENO NV
89511-1114
US

IV. Provider business mailing address

7693 S. VIRGINIA ST
RENO NV
89511-1114
US

V. Phone/Fax

Practice location:
  • Phone: 775-430-9241
  • Fax: 775-418-0430
Mailing address:
  • Phone: 775-430-9241
  • Fax: 775-418-0430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License NumberMW304
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name: MS. JACQUELINE RENAE BURGESS
Title or Position: OWNER/MIDWIFE
Credential: LM, CPM
Phone: 239-699-8718