Healthcare Provider Details

I. General information

NPI: 1124075205
Provider Name (Legal Business Name): AUDRA JO BURDULIS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AUDRA JO ESTES PA-C

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 NW SISEMORE ST STE 120
BEND OR
97703-2869
US

IV. Provider business mailing address

600 JEFFERSON ST STE 600
LAFAYETTE LA
70501-6987
US

V. Phone/Fax

Practice location:
  • Phone: 541-213-2133
  • Fax:
Mailing address:
  • Phone: 337-202-0720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA10004625
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA228080
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: