Provider Demographics
NPI:1922582659
Name:BURKET, RANDI DELA MERCED (RN)
Entity Type:Individual
Prefix:
First Name:RANDI
Middle Name:DELA MERCED
Last Name:BURKET
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 1:375 WOODSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94127-1221
Mailing Address - Country:US
Mailing Address - Phone:415-753-7811
Mailing Address - Fax:415-753-7822
Practice Address - Street 1:375 WOODSIDE AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94127-1221
Practice Address - Country:US
Practice Address - Phone:415-753-7811
Practice Address - Fax:415-753-7822
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA507104163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA507104Medicaid