Provider Demographics
NPI:1992699482
Name:BURGAMY, CHARLES JR
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:
Last Name:BURGAMY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 NE 136TH AVE APT 61
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-5976
Mailing Address - Country:US
Mailing Address - Phone:954-881-1679
Mailing Address - Fax:
Practice Address - Street 1:1441 NE 136TH AVE APT 61
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5976
Practice Address - Country:US
Practice Address - Phone:954-881-1679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-07
Last Update Date:2025-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1121901163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency