1942397310 NPI number — MRS. LAVONNE M BURROWS RN BC M-SCNS

Table of content: MRS. LAVONNE M BURROWS RN BC M-SCNS (NPI 1942397310)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942397310 NPI number — MRS. LAVONNE M BURROWS RN BC M-SCNS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURROWS
Provider First Name:
LAVONNE
Provider Middle Name:
M
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN BC M-SCNS
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:
1942397310
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/17/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5342 S HOLLAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65810-2628
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-894-6592
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 SKAGGS RD STE 302
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRANSON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65616-2062
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-334-8288
Provider Business Practice Location Address Fax Number:
417-334-6966
Provider Enumeration Date:
10/06/2006

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: 364SM0705X , with the licence number:  076456 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 126510 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1942397310 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 569325 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000083045 . This is a "MEDICARE PTAN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 500024671 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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