Provider Demographics
NPI:1457982878
Name:BURGARD, PHYLICIA M (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:PHYLICIA
Middle Name:M
Last Name:BURGARD
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:PHYLICIA
Other - Middle Name:M
Other - Last Name:FLOURE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:1023 BAKER ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43608-2714
Mailing Address - Country:US
Mailing Address - Phone:419-320-8274
Mailing Address - Fax:
Practice Address - Street 1:1023 BAKER ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-2714
Practice Address - Country:US
Practice Address - Phone:419-320-8274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-04
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.512600163WH0200X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health