Healthcare Provider Details

I. General information

NPI: 1578587044
Provider Name (Legal Business Name): LINDA M BURDETTE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 TIETON DR SUITE 200
YAKIMA WA
98902-3679
US

IV. Provider business mailing address

PO BOX 2947
YAKIMA WA
98907-2947
US

V. Phone/Fax

Practice location:
  • Phone: 509-454-2229
  • Fax: 509-454-7979
Mailing address:
  • Phone: 509-248-7849
  • Fax: 509-249-5042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberPA10000918
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: