Provider Demographics
NPI:1912409822
Name:BURDINE, CARLEIGH D (RN BSN RNC-OB)
Entity type:Individual
Prefix:
First Name:CARLEIGH
Middle Name:D
Last Name:BURDINE
Suffix:
Gender:F
Credentials:RN BSN RNC-OB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3806 S 11TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-2130
Mailing Address - Country:US
Mailing Address - Phone:615-513-9159
Mailing Address - Fax:
Practice Address - Street 1:3806 S 11TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2130
Practice Address - Country:US
Practice Address - Phone:615-513-9159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60824699163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse