Healthcare Provider Details

I. General information

NPI: 1730146754
Provider Name (Legal Business Name): LANCE R BURRELL APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7475 N SAWGRASS LN
SPRINGFIELD MO
65803-9505
US

IV. Provider business mailing address

7475 N SAWGRASS LN
SPRINGFIELD MO
65803-9505
US

V. Phone/Fax

Practice location:
  • Phone: 801-494-9451
  • Fax:
Mailing address:
  • Phone: 801-494-9451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP4694
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number17907-33
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number116581
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101.0135857
License Number StateVT
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5653727-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: