Healthcare Provider Details

I. General information

NPI: 1750425344
Provider Name (Legal Business Name): WENDEE KAY BURNETT APRN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 04/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 BARBARA LOOP SE STE B
RIO RANCHO NM
87124-1011
US

IV. Provider business mailing address

4101 BARBARA LOOP SE STE B
RIO RANCHO NM
87124-1011
US

V. Phone/Fax

Practice location:
  • Phone: 505-553-4014
  • Fax: 505-898-1559
Mailing address:
  • Phone: 505-553-4014
  • Fax: 505-898-1559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR11553
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: