Healthcare Provider Details

I. General information

NPI: 1467636670
Provider Name (Legal Business Name): BENNITA J BURKHART CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/24/2007
Last Update Date: 12/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 SOUTH 7TH AVENUE SUITE 365
WEST READING PA
19611-1436
US

IV. Provider business mailing address

3613 WYOMING DRIVE SOUTH
SINKING SPRING PA
19608-8929
US

V. Phone/Fax

Practice location:
  • Phone: 610-370-2500
  • Fax: 610-376-8239
Mailing address:
  • Phone: 610-334-0829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberSP009561
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: