Provider Demographics
NPI:1740005347
Name:BURGAD, KELLI (LPN)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:BURGAD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 NW 113TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-3758
Mailing Address - Country:US
Mailing Address - Phone:503-572-3560
Mailing Address - Fax:
Practice Address - Street 1:2621 NE 134TH ST STE 140
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-3036
Practice Address - Country:US
Practice Address - Phone:360-504-0122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6108360164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse