Provider Demographics
NPI:1073996070
Name:BURDEN, JEWEL D (PA)
Entity Type:Individual
Prefix:
First Name:JEWEL
Middle Name:D
Last Name:BURDEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JEWEL
Other - Middle Name:D
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 7549
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-0549
Mailing Address - Country:US
Mailing Address - Phone:757-686-3525
Mailing Address - Fax:757-686-0541
Practice Address - Street 1:4092 FOXWOOD DR
Practice Address - Street 2:STE 101
Practice Address - City:VA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-5225
Practice Address - Country:US
Practice Address - Phone:757-686-3525
Practice Address - Fax:757-686-0541
Is Sole Proprietor?:No
Enumeration Date:2015-07-08
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110005096363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical