Provider Demographics
NPI:1083982458
Name:BURCHARDT, NANCY ANNE
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:ANNE
Last Name:BURCHARDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3285 122ND AVE
Mailing Address - Street 2:PO DRAWER 130
Mailing Address - City:ALLEGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49010-9511
Mailing Address - Country:US
Mailing Address - Phone:800-795-6617
Mailing Address - Fax:269-673-2738
Practice Address - Street 1:3285 122ND AVE
Practice Address - Street 2:PO DRAWER 130
Practice Address - City:ALLEGAN
Practice Address - State:MI
Practice Address - Zip Code:49010-9511
Practice Address - Country:US
Practice Address - Phone:800-795-6617
Practice Address - Fax:269-673-2738
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-13
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704086300163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse