Healthcare Provider Details

I. General information

NPI: 1942397310
Provider Name (Legal Business Name): LAVONNE M BURROWS RN BC M-SCNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 10/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SKAGGS RD STE 302
BRANSON MO
65616-2062
US

IV. Provider business mailing address

5342 S HOLLAND AVE
SPRINGFIELD MO
65810-2628
US

V. Phone/Fax

Practice location:
  • Phone: 417-334-8288
  • Fax: 417-334-6966
Mailing address:
  • Phone: 417-894-6592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SM0705X
TaxonomyMedical-Surgical Clinical Nurse Specialist
License Number076456
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: