Healthcare Provider Details

I. General information

NPI: 1851557391
Provider Name (Legal Business Name): WILLIAM D. BURRUS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 08/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6161 W CHARLESTON BLVD
LAS VEGAS NV
89146-1126
US

IV. Provider business mailing address

6161 W CHARLESTON BLVD
LAS VEGAS NV
89146-1126
US

V. Phone/Fax

Practice location:
  • Phone: 702-486-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN22510
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: