Provider Demographics
NPI:1205035136
Name:BURLINGAME, ASTARA SUNRISE (RN LAC LMP RH)
Entity Type:Individual
Prefix:
First Name:ASTARA
Middle Name:SUNRISE
Last Name:BURLINGAME
Suffix:
Gender:F
Credentials:RN LAC LMP RH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7040 S 12TH ST
Mailing Address - Street 2:3909
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98465-2727
Mailing Address - Country:US
Mailing Address - Phone:206-370-0356
Mailing Address - Fax:
Practice Address - Street 1:2603 BRIDGEPORT WAY W
Practice Address - Street 2:SUITE J UNIVERSITY PLACE
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4724
Practice Address - Country:US
Practice Address - Phone:206-370-0356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00000056171100000X
WAMA000001692174400000X
WARN00055978163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No174400000XOther Service ProvidersSpecialist
No163W00000XNursing Service ProvidersRegistered Nurse