MEDICARE: MS. GINIA Y BURDICK N.P.

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	363LC1500X	Community Health Nurse Practitioner	118599	CO

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	:	1669459814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GINIA Y BURDICK N.P.

Provider Business Mailing Address
First Line	:	340 PRINTERS PKWY
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80910-3190
Country	:	US
Telephone Number	:	719-630-6440
Fax Number	:	719-228-6609

Provider Business Practice Location Address
First Line	:	7680 GODDARD ST STE 214
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-8233
Country	:	US
Telephone Number	:	719-800-1098
Fax Number	:	719-372-8307

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

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	01/24/2024

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