MEDICARE: NUGGET TAYLOR BURKHART NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	4704124126	MI
2	363L00000X	Nurse Practitioner	RN 229200 NP 16404	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316958770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NUGGET TAYLOR BURKHART NP

Provider Business Mailing Address
First Line	:	1101 CANYONWOOD CT APT 2
Second Line	:
City	:	WALNUT CREEK
State	:	CA
Zip	:	94595-3635
Country	:	US
Telephone Number	:	925-937-8747
Fax Number	:

Provider Business Practice Location Address
First Line	:	2238 GEARY BLVD # 5NW
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-3416
Country	:	US
Telephone Number	:	415-822-5126
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	07/08/2007

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