Provider Demographics
NPI:1215648662
Name:BURDETT, TERESA DIANE (DOULA)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:DIANE
Last Name:BURDETT
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 N VALLEY VIEW RD
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:PA
Mailing Address - Zip Code:16143-4429
Mailing Address - Country:US
Mailing Address - Phone:724-674-4213
Mailing Address - Fax:
Practice Address - Street 1:503 N VALLEY VIEW RD
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:PA
Practice Address - Zip Code:16143-4429
Practice Address - Country:US
Practice Address - Phone:724-674-4213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty