1609906940 NPI number — MISS PRISCILLA GEDDES BURNETT MA

Table of content: MISS PRISCILLA GEDDES BURNETT MA (NPI 1609906940)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609906940 NPI number — MISS PRISCILLA GEDDES BURNETT MA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURNETT
Provider First Name:
PRISCILLA
Provider Middle Name:
GEDDES
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
MA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609906940
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 480914
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80248-0914
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-455-0415
Provider Business Mailing Address Fax Number:
303-296-4436

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2100 BROADWAY
Provider Second Line Business Practice Location Address:
STOUT STREET BRIDGES
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80205-2526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-296-4996
Provider Business Practice Location Address Fax Number:
303-296-4436
Provider Enumeration Date:
03/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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