Provider Demographics
NPI:1922294024
Name:BURKDOLL, CATHERINE LEE (RN)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:LEE
Last Name:BURKDOLL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18360 SANTA FE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92407-1346
Mailing Address - Country:US
Mailing Address - Phone:909-887-3103
Mailing Address - Fax:
Practice Address - Street 1:18360 SANTA FE AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92407-1346
Practice Address - Country:US
Practice Address - Phone:909-887-3103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA208235163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency