Provider Demographics
NPI:1609946342
Name:BURGESS, MADELEINE CAROL (CFNP)
Entity Type:Individual
Prefix:
First Name:MADELEINE
Middle Name:CAROL
Last Name:BURGESS
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:LINDI
Other - Middle Name:CAROL
Other - Last Name:SATHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1009 GOLF COURSE RD SE STE 109
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-4705
Mailing Address - Country:US
Mailing Address - Phone:505-891-3344
Mailing Address - Fax:505-896-4499
Practice Address - Street 1:1155 COMMERCE DR
Practice Address - Street 2:SUITE G
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8257
Practice Address - Country:US
Practice Address - Phone:575-647-5337
Practice Address - Fax:575-647-5338
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1106370163W00000X
ID16072163W00000X
KY4594P363LF0000X
ID16073A363LF0000X
NMRN-84646163W00000X
NMCNP-03017363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q43627Medicare UPIN