1700918687 NPI number — MRS. LAURA ANNE BURNHAM CRNP

Table of content: MRS. LAURA ANNE BURNHAM CRNP (NPI 1700918687)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700918687 NPI number — MRS. LAURA ANNE BURNHAM CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURNHAM
Provider First Name:
LAURA
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CRNP
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:
1700918687
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8110 MAPLE LAWN BLVD STE 235
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FULTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20759-2694
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-340-8339
Provider Business Mailing Address Fax Number:
301-340-9027

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7625 MAPLE LAWN BLVD
Provider Second Line Business Practice Location Address:
STE 1, LOWER LOBBY
Provider Business Practice Location Address City Name:
FULTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20759-2565
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-531-7557
Provider Business Practice Location Address Fax Number:
410-531-0818
Provider Enumeration Date:
03/09/2007

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: 363LX0001X , with the licence number:  R144985 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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