Provider Demographics
NPI:1386878312
Name:BURKENBINE, GLORIA (LMP)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:BURKENBINE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 6TH AVE SE STE 202
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1042
Mailing Address - Country:US
Mailing Address - Phone:360-539-7726
Mailing Address - Fax:360-539-7729
Practice Address - Street 1:4200 6TH AVE SE
Practice Address - Street 2:SUITE 202
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1042
Practice Address - Country:US
Practice Address - Phone:360-539-7726
Practice Address - Fax:360-539-7729
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024646174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist