Healthcare Provider Details

I. General information

NPI: 1639492812
Provider Name (Legal Business Name): REESHEMAH K BURGESS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2010
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

847 SUMPTER RD # 494
VAN BUREN TOWNSHIP MI
48111-4905
US

IV. Provider business mailing address

847 SUMPTER RD # 494
VAN BUREN TOWNSHIP MI
48111-4905
US

V. Phone/Fax

Practice location:
  • Phone: 870-225-9558
  • Fax:
Mailing address:
  • Phone: 870-225-9558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704419198
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: