=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699929869
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAROLYN A BURNETT RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2008
-----------------------------------------------------
Last Update Date | 11/13/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 601 N 8 MILE RD
-----------------------------------------------------
City | CASPER
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82604-9620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-259-1076
-----------------------------------------------------
Fax | 307-333-0221
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 301 THELMA DR # 422
-----------------------------------------------------
City | CASPER
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82609-2325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-259-1076
-----------------------------------------------------
Fax | 307-333-0221
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 16660
-----------------------------------------------------
License Number State | WY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163WH0200X
-----------------------------------------------------
Taxonomy Name | Home Health Registered Nurse
-----------------------------------------------------
License Number | 16660
-----------------------------------------------------
License Number State | WY
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 163WI0500X
-----------------------------------------------------
Taxonomy Name | Infusion Therapy Registered Nurse
-----------------------------------------------------
License Number | 16660
-----------------------------------------------------
License Number State | WY
-----------------------------------------------------