Healthcare Provider Details

I. General information

NPI: 1821620071
Provider Name (Legal Business Name): MARTIA BURDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2020
Last Update Date: 05/23/2020
Certification Date: 05/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S 11TH ST
PHILADELPHIA PA
19107-4824
US

IV. Provider business mailing address

833 CHESTNUT ST STE 701
PHILADELPHIA PA
19107-4409
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-2146
  • Fax:
Mailing address:
  • Phone: 215-955-2146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN665668
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberSP021693
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: