Healthcare Provider Details

I. General information

NPI: 1023483807
Provider Name (Legal Business Name): RICHARD JOSEPH BURTNETT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2015
Last Update Date: 12/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL PARK
WHEELING WV
26003-6379
US

IV. Provider business mailing address

508 NICHOLS RD
PITTSBURGH PA
15237-3311
US

V. Phone/Fax

Practice location:
  • Phone: 304-243-3060
  • Fax:
Mailing address:
  • Phone: 412-951-0391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN608075
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number90335
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: