Provider Demographics
NPI:1366494478
Name:BURBACH, JEAN ANN (RXN,CNS)
Entity type:Individual
Prefix:MS
First Name:JEAN
Middle Name:ANN
Last Name:BURBACH
Suffix:
Gender:F
Credentials:RXN,CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 OBSERVATORY DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-3970
Mailing Address - Country:US
Mailing Address - Phone:719-471-4049
Mailing Address - Fax:719-471-2023
Practice Address - Street 1:514 OBSERVATORY DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-3970
Practice Address - Country:US
Practice Address - Phone:719-471-4049
Practice Address - Fax:719-471-2023
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9836364SP0808X
CO90570363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health