Healthcare Provider Details

I. General information

NPI: 1326623935
Provider Name (Legal Business Name): NATALIE BURNINGHAM MT-BC, IBDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2021
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

485 MEADOW LN
PROVIDENCE UT
84332-9819
US

IV. Provider business mailing address

485 MEADOW LN
PROVIDENCE UT
84332-9819
US

V. Phone/Fax

Practice location:
  • Phone: 303-887-1070
  • Fax:
Mailing address:
  • Phone: 303-887-1070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number9203390-4010
License Number StateUT
# 4
Primary TaxonomyY
Taxonomy Code246X00000X
TaxonomyCardiovascular Specialist/Technologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: