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Individual

CYNTHIA LEE BURGHARDT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LPN

Contact information

Practice address
9484 OSWEGO RD, PHOENIX, NY 13135-9508
(315) 695-6888
Mailing address
9484 OSWEGO RD, PHOENIX, NY 13135-9508
(315) 695-6888

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
097263-1
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
02053776
NY
Enumeration date
05/07/2008
Last updated
05/07/2008
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