Healthcare Provider Details

I. General information

NPI: 1497083380
Provider Name (Legal Business Name): ALICE F BURDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2009
Last Update Date: 02/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5350 TALLMAN AVE NW STE 301
SEATTLE WA
98107-5902
US

IV. Provider business mailing address

PO BOX 25608
SALT LAKE CITY UT
84125-0608
US

V. Phone/Fax

Practice location:
  • Phone: 206-320-3335
  • Fax: 206-320-8027
Mailing address:
  • Phone: 206-320-4476
  • Fax: 206-568-7043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60118144
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: