Individual
DR. PENNY ILENE BURDICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
91 BRITTANY LN, SEQUIM, WA 98382-9360
(360) 461-4538
(360) 477-4824
Mailing address
PO BOX 664, CARLSBORG, WA 98324-0664
(360) 461-4538
(360) 477-4824
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD00024778
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0245680
WA STATE L&I PROVIDER ACCT. #
WA
05
—
1127190
—
WA
01
—
3296BU
REGENCE PPN
WA
Enumeration date
09/16/2006
Last updated
04/30/2009
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