MEDICARE: LAURA BURSE

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	500224	TX

General Provider Information

NPI Number	:	1568057685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA BURSE

Provider Business Mailing Address
First Line	:	6721 PARK HVN
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78244-2048
Country	:	US
Telephone Number	:	210-844-3768
Fax Number	:

Provider Business Practice Location Address
First Line	:	6721 PARK HVN
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78244-2048
Country	:	US
Telephone Number	:	210-844-3768
Fax Number	:

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

Provider Enumeration Date	:	03/02/2021
Last Update Date	:	03/02/2021

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Directions to “ LAURA BURSE ” Practice Location

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