Healthcare Provider Details

I. General information

NPI: 1962327031
Provider Name (Legal Business Name): BRAE LAUREN BURR FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. BRAE LAUREN WEAVER

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SEYMOUR RD
UTICA NY
13502-1311
US

IV. Provider business mailing address

100 SEYMOUR RD
UTICA NY
13502-1311
US

V. Phone/Fax

Practice location:
  • Phone: 315-792-7347
  • Fax: 315-792-7837
Mailing address:
  • Phone: 315-792-7347
  • Fax: 315-792-7837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number360034
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: