Healthcare Provider Details

I. General information

NPI: 1003608266
Provider Name (Legal Business Name): AMANDA BURNETT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2025
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27371 S 4410 RD
VINITA OK
74301-7953
US

IV. Provider business mailing address

10911 W PEORIA CIR
MIAMI OK
74354-4573
US

V. Phone/Fax

Practice location:
  • Phone: 918-351-9853
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberR0086465
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: