| NPI | 1952945537 |
|---|---|
| Former Name | JACKIE BURDITT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2020011329) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2016033305) |
| 163W00000X Registered Nurse (Licence: KS 14-147955-092) | |
| Enumeration Date | 2019-11-06 |
| Last Update Date | 2020-09-02 |