Provider Demographics
NPI:1912278045
Name:BURSAW, CHRISTINE (RN)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:BURSAW
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 1:4788 PONDEROSA DR
Mailing Address - Street 2:#A
Mailing Address - City:USAF ACADEMY
Mailing Address - State:CO
Mailing Address - Zip Code:80840-1232
Mailing Address - Country:US
Mailing Address - Phone:719-578-3297
Mailing Address - Fax:
Practice Address - Street 1:1675 GARDEN OF THE GODS RD
Practice Address - Street 2:STE 2044
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-9444
Practice Address - Country:US
Practice Address - Phone:719-578-3297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO200095163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse