Healthcare Provider Details

I. General information

NPI: 1184686545
Provider Name (Legal Business Name): KATHLEEN A. BURNHAM C.R.N.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 BELMONT ST
WORCESTER MA
01605-2903
US

IV. Provider business mailing address

119 BELMONT ST
WORCESTER MA
01605-2903
US

V. Phone/Fax

Practice location:
  • Phone: 508-334-6491
  • Fax:
Mailing address:
  • Phone: 508-334-6491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number91243
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: