Provider Demographics
NPI:1699828442
Name:BURRUEL DUARTE, LINDA ALICE (LPN)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:ALICE
Last Name:BURRUEL DUARTE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SUNNYSIDE UNIFIED SCHOOL DISTRICT NO 12
Mailing Address - Street 2:2238 E GINTER ROAD
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:95706
Mailing Address - Country:US
Mailing Address - Phone:520-545-2137
Mailing Address - Fax:520-545-2120
Practice Address - Street 1:SUNNYSIDE UNIFIED SCHOOL DISTRICT NO 12
Practice Address - Street 2:2238 E GINTER ROAD
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:95706
Practice Address - Country:US
Practice Address - Phone:520-545-2137
Practice Address - Fax:520-545-2120
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP023312164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse