Provider Demographics
NPI:1457471351
Name:BURGWINKEL, GARDA M (RN)
Entity Type:Individual
Prefix:MRS
First Name:GARDA
Middle Name:M
Last Name:BURGWINKEL
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 1:85 ARLINGTON ST
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-2727
Mailing Address - Country:US
Mailing Address - Phone:978-660-5815
Mailing Address - Fax:
Practice Address - Street 1:85 ARLINGTON ST
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-2727
Practice Address - Country:US
Practice Address - Phone:978-660-5815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA194655163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0706116Medicaid