Healthcare Provider Details

I. General information

NPI: 1780159624
Provider Name (Legal Business Name): TERESA ELAINE BURNETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2018
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 WARREN AVE STE 1
FRONT ROYAL VA
22630-4480
US

IV. Provider business mailing address

279 ALEXANDRIA PIKE
WARRENTON VA
20186-2939
US

V. Phone/Fax

Practice location:
  • Phone: 540-456-2460
  • Fax:
Mailing address:
  • Phone: 540-497-1454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024176710
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: