Provider Demographics
NPI:1598306052
Name:BURKHOLDER, TATIANA (DNP)
Entity Type:Individual
Prefix:
First Name:TATIANA
Middle Name:
Last Name:BURKHOLDER
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:MS
Other - First Name:TATIANA
Other - Middle Name:
Other - Last Name:HORTIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 JOHN ST STE M-124
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5377
Mailing Address - Country:US
Mailing Address - Phone:269-341-7540
Mailing Address - Fax:
Practice Address - Street 1:601 JOHN ST STE M-124
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5377
Practice Address - Country:US
Practice Address - Phone:269-341-7540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704345689363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care