Healthcare Provider Details

I. General information

NPI: 1053683870
Provider Name (Legal Business Name): ELENA BURKHART PA - C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELENA DANNENMAIER PA-C

II. Dates (important events)

Enumeration Date: 02/09/2012
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6830 ADRIENNE ARBOR DR STE 520
SPRING TX
77389-2153
US

IV. Provider business mailing address

920 MEDICAL PLAZA DR STE 520
THE WOODLANDS TX
77380-3204
US

V. Phone/Fax

Practice location:
  • Phone: 409-789-2710
  • Fax: 979-282-5727
Mailing address:
  • Phone: 832-562-3974
  • Fax: 832-663-3978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA07691
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: