Provider Demographics
NPI:1235662040
Name:BURCHARD, MONIQUE S (FNP)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:S
Last Name:BURCHARD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MLK JR BLVD
Mailing Address - Street 2:SUITE 200 (CENTRAL MASS ALLERGY AND ASTHMA CARE)
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1209
Mailing Address - Country:US
Mailing Address - Phone:508-757-1589
Mailing Address - Fax:
Practice Address - Street 1:100 MLK JR BLVD
Practice Address - Street 2:SUITE 200 (CENTRAL MASS ALLERGY AND ASTHMA CARE)
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1209
Practice Address - Country:US
Practice Address - Phone:508-757-1589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2279761363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily