Provider Demographics
NPI:1699804450
Name:BURLAKOFF, TERRY L (RN, CDE)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:L
Last Name:BURLAKOFF
Suffix:
Gender:F
Credentials:RN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S HILLSIDE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-2152
Mailing Address - Country:US
Mailing Address - Phone:316-687-3100
Mailing Address - Fax:316-687-0286
Practice Address - Street 1:200 S HILLSIDE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-2152
Practice Address - Country:US
Practice Address - Phone:316-687-3100
Practice Address - Fax:316-687-0286
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1336962051163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS130651Medicare ID - Type Unspecified