Provider Demographics
NPI:1003861584
Name:BURWICK, CHERYL L (RN, MSN, CFNP)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:L
Last Name:BURWICK
Suffix:
Gender:F
Credentials:RN, MSN, CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79401-3206
Mailing Address - Country:US
Mailing Address - Phone:806-765-2611
Mailing Address - Fax:806-741-3012
Practice Address - Street 1:1313 BROADWAY
Practice Address - Street 2:SUITE 5
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79401-3277
Practice Address - Country:US
Practice Address - Phone:806-765-2611
Practice Address - Fax:806-765-2604
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX545980363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157807201Medicaid
TX157807201Medicaid
TX8A5009Medicare ID - Type Unspecified