Healthcare Provider Details

I. General information

NPI: 1750498580
Provider Name (Legal Business Name): JENNIFER ANN BURNETT MS, MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 03/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 ROSE AVE
SELMA CA
93662-3240
US

IV. Provider business mailing address

955 POWELL AVE SW
RENTON WA
98057-2908
US

V. Phone/Fax

Practice location:
  • Phone: 559-856-6090
  • Fax: 559-856-6092
Mailing address:
  • Phone: 425-277-1311
  • Fax: 425-277-1566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00044561
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: