MEDICARE: MS. LAURA HELEN BURNETT PSY.N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	202001251NP-PP	OR

General Provider Information

NPI Number	:	1487772364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURA HELEN BURNETT PSY.N.P.

Provider Business Mailing Address
First Line	:	13535 SW 72ND AVE STE 170
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97223-8074
Country	:	US
Telephone Number	:	971-300-0654
Fax Number	:

Provider Business Practice Location Address
First Line	:	1132 SW 13TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97205-1703
Country	:	US
Telephone Number	:	971-419-6612
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	04/20/2023

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