Healthcare Provider Details

I. General information

NPI: 1730559253
Provider Name (Legal Business Name): BREANNA BURDICK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BREANNA DUNSMORE PA-C

II. Dates (important events)

Enumeration Date: 09/26/2015
Last Update Date: 05/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 W 26TH ST ORTHOPEDIC SURGEONS INC.
ERIE PA
16508-1806
US

IV. Provider business mailing address

411 W 7TH ST 2ND FLOOR
ERIE PA
16502-1330
US

V. Phone/Fax

Practice location:
  • Phone: 814-454-2401
  • Fax:
Mailing address:
  • Phone: 814-335-2968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA057884
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: