MEDICARE: CHRISTINE FELICIA BURG 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	363LF0000X	Family Nurse Practitioner	NP95002662	CA

General Provider Information

NPI Number	:	1740665405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE FELICIA BURG NP

Provider Business Mailing Address
First Line	:	35 CASA ST STE 320
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93405-1894
Country	:	US
Telephone Number	:	805-250-4844
Fax Number	:	805-785-0356

Provider Business Practice Location Address
First Line	:	35 CASA ST STE 320
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93405-1894
Country	:	US
Telephone Number	:	805-250-4844
Fax Number	:	805-785-0356

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

Provider Enumeration Date	:	07/23/2015
Last Update Date	:	04/06/2018

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