Provider Demographics
NPI:1306131230
Name:BURDICK, BOBBIE KRISTI (APRN, CNP)
Entity type:Individual
Prefix:
First Name:BOBBIE
Middle Name:KRISTI
Last Name:BURDICK
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:BOBBIE
Other - Middle Name:KRISTI
Other - Last Name:SURLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, CNP
Mailing Address - Street 1:400 E 3RD ST
Mailing Address - Street 2:DULUTH CLINIC
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-1951
Mailing Address - Country:US
Mailing Address - Phone:218-786-8364
Mailing Address - Fax:
Practice Address - Street 1:400 E 3RD ST
Practice Address - Street 2:DULUTH CLINIC
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-1951
Practice Address - Country:US
Practice Address - Phone:218-786-8364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR134737-7363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1306131230Medicaid
MN0004-0016498OtherMEDICA
MN1306131230Medicaid
WI1306131230Medicaid
MI1306131230Medicaid