Provider Demographics
NPI:1366461840
Name:BURDICK, BECKY JO (PA-C)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:JO
Last Name:BURDICK
Suffix:
Gender:F
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:710 COMMERCE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-4925
Mailing Address - Country:US
Mailing Address - Phone:651-968-5042
Mailing Address - Fax:651-968-5904
Practice Address - Street 1:1185 TOWN CENTRE DR STE 100
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55123-1188
Practice Address - Country:US
Practice Address - Phone:651-968-5200
Practice Address - Fax:651-968-5903
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2021-12-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN9606363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN970006695Medicare PIN