Healthcare Provider Details

I. General information

NPI: 1104123355
Provider Name (Legal Business Name): WILLIAM W. BURLINGAME CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: WILLIAM W. BURLINGAME

II. Dates (important events)

Enumeration Date: 02/24/2011
Last Update Date: 02/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 WARWICK CIRCLE EAST
LONGVIEW TX
75601-3134
US

IV. Provider business mailing address

1907 WARWICK CIRCLEEAST
LONGVIEW TX
75601-3134
US

V. Phone/Fax

Practice location:
  • Phone: 903-757-4453
  • Fax:
Mailing address:
  • Phone: 903-757-4453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number736487
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: