Provider Demographics
NPI:1669459814
Name:BURDICK, GINIA Y (NP)
Entity Type:Individual
Prefix:MS
First Name:GINIA
Middle Name:Y
Last Name:BURDICK
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:340 PRINTERS PKWY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-3190
Mailing Address - Country:US
Mailing Address - Phone:719-630-6440
Mailing Address - Fax:719-228-6609
Practice Address - Street 1:7680 GODDARD ST STE 214
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-8233
Practice Address - Country:US
Practice Address - Phone:719-800-1098
Practice Address - Fax:719-372-8307
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2024-01-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO118599363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO84288345Medicaid
CO84288345Medicaid
CO516878Medicare ID - Type Unspecified