Healthcare Provider Details

I. General information

NPI: 1831188143
Provider Name (Legal Business Name): MARSHA JEANE BURRIS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 04/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 E. ROCK HAVEN RD. SUITE 100
HARRISONVILLE MO
64701-2082
US

IV. Provider business mailing address

2820 E. ROCK HAVEN RD. SUITE 100
HARRISONVILLE MO
64701-2082
US

V. Phone/Fax

Practice location:
  • Phone: 816-380-3582
  • Fax: 816-380-6964
Mailing address:
  • Phone: 816-380-3582
  • Fax: 816-380-6964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number089157
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: