Healthcare Provider Details

I. General information

NPI: 1346533023
Provider Name (Legal Business Name): CATHLEEN ANGELA BURGESS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2011
Last Update Date: 05/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USAG-J UNIT 45013 BOX 2746
APO AP
96338
US

IV. Provider business mailing address

USAG-J UNIT 45013 BOX 2746
APO AP
96338
US

V. Phone/Fax

Practice location:
  • Phone: 315-263-5259
  • Fax: 315-263-3866
Mailing address:
  • Phone: 315-263-5259
  • Fax: 315-263-3866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number1-075128
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: