Provider Demographics
NPI:1942580634
Name:BURCHAK, ANGELA B (CNP)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:B
Last Name:BURCHAK
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 LAKE DECADE CT
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-8331
Mailing Address - Country:US
Mailing Address - Phone:985-868-4333
Mailing Address - Fax:985-868-4390
Practice Address - Street 1:459 CORPORATE DR
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-2462
Practice Address - Country:US
Practice Address - Phone:985-868-4333
Practice Address - Fax:985-868-4390
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04775363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily