Individual
NICOLE M BURGBACHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
4160 LITTLE YORK RD, SUITE 10, DAYTON, OH 45414-5800
(937) 415-9100
(937) 415-9191
Mailing address
PO BOX 713130, CINCINNATI, OH 45271-0001
(937) 415-9100
(937) 415-9191
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50002158
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00822690
RR MCR
OH
Enumeration date
07/05/2006
Last updated
09/13/2012
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