Healthcare Provider Details

I. General information

NPI: 1972049054
Provider Name (Legal Business Name): VANESSA MARIE BURNS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VANESSA MARIE BUSTOS

II. Dates (important events)

Enumeration Date: 01/12/2017
Last Update Date: 04/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 NW 12TH AVE
MIAMI FL
33136-1051
US

IV. Provider business mailing address

1650 COWLES ST
FAIRBANKS AK
99701-5907
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-1111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number115640
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: