Healthcare Provider Details

I. General information

NPI: 1043030745
Provider Name (Legal Business Name): SARITA RENAE BURNETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARITA RENAE BURNETT

II. Dates (important events)

Enumeration Date: 10/16/2024
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2708 E 10TH ST
GREENVILLE NC
27858-3149
US

IV. Provider business mailing address

2708 E 10TH ST STE 27082708
GREENVILLE NC
27858-3149
US

V. Phone/Fax

Practice location:
  • Phone: 252-364-9789
  • Fax: 252-364-9789
Mailing address:
  • Phone: 252-364-9789
  • Fax: 252-364-9789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number335E00000X
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: