Provider Demographics
NPI:1790137909
Name:BURD, ANGELA THERESE
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:THERESE
Last Name:BURD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64169 COUNTY ROAD 665
Mailing Address - Street 2:
Mailing Address - City:PAW PAW
Mailing Address - State:MI
Mailing Address - Zip Code:49079-9200
Mailing Address - Country:US
Mailing Address - Phone:269-657-0076
Mailing Address - Fax:
Practice Address - Street 1:64169 COUNTY ROAD 665
Practice Address - Street 2:
Practice Address - City:PAW PAW
Practice Address - State:MI
Practice Address - Zip Code:49079-9200
Practice Address - Country:US
Practice Address - Phone:269-657-0076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other