Healthcare Provider Details

I. General information

NPI: 1407927155
Provider Name (Legal Business Name): MAE DE ETTE BURTON F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEETTE M BURTON NP

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 E GREENVILLE ST STE 5130
ANDERSON SC
29621-1580
US

IV. Provider business mailing address

PO BOX 100174
COLUMBIA SC
29202-3174
US

V. Phone/Fax

Practice location:
  • Phone: 864-512-4590
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN2534
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: