Provider Demographics
NPI:1891009312
Name:BURDINE, CHASITEE QWINETTE
Entity type:Individual
Prefix:
First Name:CHASITEE
Middle Name:QWINETTE
Last Name:BURDINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHASITEE
Other - Middle Name:QWINETTE
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CASE MANAGER (CMII)
Mailing Address - Street 1:1201 N UNION AVE
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74801-5022
Mailing Address - Country:US
Mailing Address - Phone:405-650-7738
Mailing Address - Fax:
Practice Address - Street 1:57533 MOCCASIN TRAIL RD
Practice Address - Street 2:
Practice Address - City:PRAGUE
Practice Address - State:OK
Practice Address - Zip Code:74864
Practice Address - Country:US
Practice Address - Phone:405-567-0054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor