Provider Demographics
NPI:1811504749
Name:BURTCH, MAGGIE MCNEAL (RN, MS)
Entity type:Individual
Prefix:MRS
First Name:MAGGIE
Middle Name:MCNEAL
Last Name:BURTCH
Suffix:
Gender:F
Credentials:RN, MS
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Other - Last Name:
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Mailing Address - Street 1:1307 MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-2224
Mailing Address - Country:US
Mailing Address - Phone:614-746-2905
Mailing Address - Fax:
Practice Address - Street 1:1104 BUCHANAN RD STE C10
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-4226
Practice Address - Country:US
Practice Address - Phone:415-476-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-24
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95173896163W00000X
CA95015809363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty