Healthcare Provider Details

I. General information

NPI: 1124767983
Provider Name (Legal Business Name): PATRICIA DAWN BURTON BSN, RN, CCM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DAWN SAPP BURTON BSN, RN, CCM

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 05/31/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4625 SHATTALON CIR
WINSTON SALEM NC
27106-1821
US

IV. Provider business mailing address

4625 SHATTALON CIR
WINSTON SALEM NC
27106-1821
US

V. Phone/Fax

Practice location:
  • Phone: 336-999-3330
  • Fax: 877-211-6810
Mailing address:
  • Phone: 336-407-8838
  • Fax: 877-211-6810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number096571
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: