Healthcare Provider Details

I. General information

NPI: 1487901765
Provider Name (Legal Business Name): DONNA LIDEL BURLEY MS, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2012
Last Update Date: 12/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 DUNCAN ROAD
BUCKEYE WV
24924-9037
US

IV. Provider business mailing address

150 DUNCAN ROAD
BUCKEYE WV
24924-9037
US

V. Phone/Fax

Practice location:
  • Phone: 304-799-4700
  • Fax: 304-799-2276
Mailing address:
  • Phone: 304-799-4700
  • Fax: 304-799-2276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number62078
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: