Healthcare Provider Details

I. General information

NPI: 1720232838
Provider Name (Legal Business Name): CONNIE L BURNS ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2008
Last Update Date: 11/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 DE LONG AVE SUITE 100
NOVATO CA
04045-3246
US

IV. Provider business mailing address

800 DE LONG AVE SUITE 100
NOVATO CA
94945-3246
US

V. Phone/Fax

Practice location:
  • Phone: 415-892-8992
  • Fax: 415-892-8962
Mailing address:
  • Phone: 415-892-8992
  • Fax: 415-892-8962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND 156
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: