MEDICARE: LARAMIE BURDEN

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	RN.401132	OH
2	363L00000X	Nurse Practitioner	APRN.CNP.026027	OH

General Provider Information

NPI Number	:	1841834835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARAMIE BURDEN

Provider Business Mailing Address
First Line	:	150 TAYLOR STATION RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-4440
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 TAYLOR STATION RD STE 200
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-4470
Country	:	US
Telephone Number	:	614-627-1300
Fax Number	:	614-627-1304

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

Provider Enumeration Date	:	11/01/2019
Last Update Date	:	09/17/2020

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Directions to “ LARAMIE BURDEN ” Practice Location

Language	Start Address	Practice Location

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