Healthcare Provider Details

I. General information

NPI: 1720210362
Provider Name (Legal Business Name): BABETTE RENE BURGAN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2009
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

992 COOKE ST
WATERBURY CT
06704-1912
US

IV. Provider business mailing address

PO BOX 1191
WEBSTER NY
14580-7891
US

V. Phone/Fax

Practice location:
  • Phone: 877-544-4446
  • Fax:
Mailing address:
  • Phone: 914-275-7740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number606785-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF309419-01
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number12.017162
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: