Provider Demographics
NPI:1104186881
Name:BURDULIS, ALLISON (CNM)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:BURDULIS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 E OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-4651
Mailing Address - Country:US
Mailing Address - Phone:215-348-4002
Mailing Address - Fax:
Practice Address - Street 1:54 E OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-4651
Practice Address - Country:US
Practice Address - Phone:215-348-4002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-29
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25ME00050500367A00000X
PAMW010291367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife