AUDRA JO BURDULIS (NPI# 1124075205) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124075205 |
| Entity Type | Individual |
| Full Name | AUDRA JO BURDULIS |
| Other Name | AUDRA JO ESTES |
| Credential | PA-C |
| Practice Address |
3600 Lind Ave Sw Ste 170 Renton WA 98057-4934 |
| Mailing Address |
3600 Lind Ave Sw Ste 100 Attn Credentialing Renton WA 98057-4970 |
| Practice Telephone | 4256565020 |
| Practice Fax Number | 4256565019 |
| Mailing Telephone | 4256902715 |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2020-04-03 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA10004625 | WA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | MEDICARE W VALLEY MEDICAL GROUP - RENTON | G8891360 | 01 |
| WA | 2009751 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 7203 129th Ave Se Ste 100, Newcastle, WA 980561412 | 4256903455 | 4256909455 |
| Street Address |
3600 LIND AVE SW STE 170 |
| City | RENTON |
| State | WA |
| Zip Code | 98057-4934 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508405010 | Johanna Marie Karn | Occupational Therapist | 3600 Lind Ave Sw Ste 170, Renton, WA 98057-4934 | 2019-12-31 |
| 1992286488 | Divina Marie Ramolete | Occupational Therapist | 3600 Lind Ave Sw Ste 170, Renton, WA 98057-4934 | 2018-08-23 |
| 1558859520 | Gwynne Laura Schroeder | Occupational Therapist | 3600 Lind Ave Sw Ste 170, Renton, WA 98057-4934 | 2018-04-25 |
| 1124538343 | Natasha B Arora | Speech-Language Pathologist | 3600 Lind Ave Sw Ste 170, Renton, WA 98057-4934 | 2017-10-02 |
| 1992135545 | Patrick John Czaplicki | Physician Assistant | 3600 Lind Ave Sw Ste 170, Renton, WA 98057-4934 | 2013-11-18 |
| 1336297498 | Scott D Morris | Preventive Medicine | 3600 Lind Ave Sw Ste 170, Renton, WA 98057-4934 | 2007-01-08 |
| 1528126448 | Louis W. Lim | Preventive Medicine | 3600 Lind Ave Sw Ste 170, Renton, WA 98057-4934 | 2006-12-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043856628 | Megan Ramaiya | Student in an Organized Health Care Education/Training Program | King Count Sexual Assault & Resource Center, 200 Mill Ave S # 10, Renton, WA 98057 | 2019-11-19 |
| 1063076255 | Breanne Michele Smiley | Specialist/Technologist | 737 Logan Ave N, Renton, WA 98057 | 2019-04-24 |
| 1093215063 | Laura Lewis | Physical Medicine & Rehabilitation | 1000 Oakesdale Ave Sw Ste 100, Renton, WA 98057 | 2018-02-16 |
| 1437676004 | Ralph William Papke Jr. | Counselor | Kaiser Permanente of Wa, 1200 Sw 27th St, Renton, WA 98057 | 2017-08-24 |
| 1487106456 | Serengeti Care Partners LLC | Community/Behavioral Health | 707 S- Grady Way, Suite 6008, Renton, WA 98057 | 2016-10-26 |
| 1548716152 | Phandinh Ngoc Nguyen | Naturopath | 330 Sw 43rd St,suite L, Renton, WA 98057 | 2016-09-01 |
| 1275905721 | Todd R Glass | Chiropractor | 1024 N 10th Pl #2306, Renton, WA 98057 | 2015-10-23 |
| 1134595341 | Have A Heart | Case Management | 151 Taylor Ave Nw, Renton, WA 98057 | 2015-08-12 |
| 1780087171 | Brianne N Lefferts | Physical Therapist | 300 Sw 7th Street, Renton, WA 98057 | 2014-09-30 |
| 1588089460 | Sound Association Western Washington LLC | Audiologist | 108 Factory Ave. N., Ste 2b, Renton, WA 98057 | 2014-02-28 |
| Find all providers in zip 98057 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962422956 | Charles J Davis | Physician Assistant | 14410 Se Petrovitsky Rd Ste 104, Renton, WA 98058-8900 | 2006-07-20 |
| 1255365219 | Gretchen Paige Wix | Physician Assistant | 800 Logan Ave N, Building 4-04, Medical, Renton, WA 98055-2080 | 2006-07-10 |
| 1649227380 | Public Hospital District #1 of King County | Physician Assistant | 14410 Se Petrovitsky Rd, Suite 104, Renton, WA 98058-8900 | 2006-05-28 |
| 1154804854 | Alexandra Hurtado Dammen | Physician Assistant | 400 S 43rd St, Renton, WA 98055-5714 | 2018-09-10 |
| 1679018063 | Lindsey Paige O'donnell | Physician Assistant | 10555 Se Carr Rd, Bldg M, Renton, WA 98055-5820 | 2016-12-21 |
| 1437521655 | Marion Rose Larson | Physician Assistant | 707 S Grady Way Ste 600, Renton, WA 98057-3227 | 2015-10-27 |
| 1780989210 | Ashley Lorene Miguel | Physician Assistant | 350 S 38th Ct, Ste 115, Renton, WA 98055-5777 | 2011-01-13 |
| 1477888592 | Cheryl Lefler Cieszlak | Physician Assistant | 4033 Talbot Rd S, Ste 530, Renton, WA 98055-5772 | 2009-10-07 |
| 1700031861 | Dwayne Eric Hammond | Physician Assistant | 500 Sw 39th St, Suite 150, Renton, WA 98057-4915 | 2008-11-17 |
| 1053469494 | Michael A. Erickson | Physician Assistant | 275 Bronson Way Ne, Renton, WA 98056-4030 | 2007-01-08 |
| Find all providers in RENTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.