Healthcare Provider Details

I. General information

NPI: 1821025339
Provider Name (Legal Business Name): SONDRA J BURLESON CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 05/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 W 32ND ST
JOPLIN MO
64804-3503
US

IV. Provider business mailing address

PO BOX 3810
JOPLIN MO
64803
US

V. Phone/Fax

Practice location:
  • Phone: 417-347-1111
  • Fax:
Mailing address:
  • Phone: 417-624-8566
  • Fax: 417-623-9932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number072383
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: