Provider Demographics
NPI:1922289024
Name:BURDINE, ROBERT GLENN (RN)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:GLENN
Last Name:BURDINE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3531
Mailing Address - Street 2:
Mailing Address - City:YUMA PROVING GROUND
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-0911
Mailing Address - Country:US
Mailing Address - Phone:928-328-3020
Mailing Address - Fax:
Practice Address - Street 1:4TH & INNER LOOP
Practice Address - Street 2:
Practice Address - City:FT. IRWIN
Practice Address - State:CA
Practice Address - Zip Code:92310-5109
Practice Address - Country:US
Practice Address - Phone:928-328-3020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN134298163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse