Provider Demographics
NPI:1124609706
Name:BURGARD, KAREN (NBC-HWC)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:BURGARD
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 CYNTHIA DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGMAN
Mailing Address - State:MI
Mailing Address - Zip Code:49106-9336
Mailing Address - Country:US
Mailing Address - Phone:219-617-2120
Mailing Address - Fax:
Practice Address - Street 1:5050 CYNTHIA DR
Practice Address - Street 2:
Practice Address - City:BRIDGMAN
Practice Address - State:MI
Practice Address - Zip Code:49106-9336
Practice Address - Country:US
Practice Address - Phone:219-617-2120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3345509