Provider Demographics
NPI:1558345827
Name:BURBANK, PATRICIA JEAN (RN MSN APN)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:JEAN
Last Name:BURBANK
Suffix:
Gender:F
Credentials:RN MSN APN
Other - Prefix:MRS
Other - First Name:PATRICIA
Other - Middle Name:JEAN
Other - Last Name:BUCZKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 ORONDO AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2800
Mailing Address - Country:US
Mailing Address - Phone:509-662-6000
Mailing Address - Fax:509-664-4590
Practice Address - Street 1:900 EASTMONT AVE
Practice Address - Street 2:
Practice Address - City:EAST WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98802-6602
Practice Address - Country:US
Practice Address - Phone:509-884-9000
Practice Address - Fax:509-884-9001
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209005176363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL358647186001Medicaid
Q27145Medicare UPIN
IL358647186001Medicaid