MEDICARE: BRIANNA BURDETTE RN

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	163W00000X	Registered Nurse	806415	NY

General Provider Information

NPI Number	:	1508457094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIANNA BURDETTE RN

Provider Business Mailing Address
First Line	:	274 CENTRAL AVE APT 1
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07307-3013
Country	:	US
Telephone Number	:	205-535-6250
Fax Number	:

Provider Business Practice Location Address
First Line	:	274 CENTRAL AVE APT 1
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07307-3013
Country	:	US
Telephone Number	:	205-535-6250
Fax Number	:

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

Provider Enumeration Date	:	01/28/2021
Last Update Date	:	01/28/2021

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