Healthcare Provider Details

I. General information

NPI: 1750460788
Provider Name (Legal Business Name): ROXANNE CATHERINE BURNSVATTER RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18925 EL BELLO PASEO
MONROE WA
98272-9401
US

IV. Provider business mailing address

PO BOX 941
MONROE WA
98272-0941
US

V. Phone/Fax

Practice location:
  • Phone: 425-760-3587
  • Fax:
Mailing address:
  • Phone: 425-760-3587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN00131242
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: