Provider Demographics
NPI:1265844351
Name:BURGDORFER, AUDREY (RN)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:BURGDORFER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26455 ROCKWELL CANYON RD
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-1803
Mailing Address - Country:US
Mailing Address - Phone:661-362-3259
Mailing Address - Fax:
Practice Address - Street 1:26455 ROCKWELL CANYON RD
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91355-1803
Practice Address - Country:US
Practice Address - Phone:661-362-3259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-23
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA568509163WC1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1400XNursing Service ProvidersRegistered NurseCollege Health