Healthcare Provider Details

I. General information

NPI: 1710715487
Provider Name (Legal Business Name): ALISON MARIE BURGESS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2024
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2575 MCLEOD DR N
SAGINAW MI
48604-2857
US

IV. Provider business mailing address

1235 WILSON AVE
SAGINAW MI
48638-4755
US

V. Phone/Fax

Practice location:
  • Phone: 989-797-5532
  • Fax:
Mailing address:
  • Phone: 989-860-8546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704321276
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: