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General NPI Number Information
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NPI Number | 1811810104
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Entity Type | Individual
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Provider Name | DESTINY RAYNE BURT APRN
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Gender | Female
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Dates
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Enumeration Date | 08/03/2026
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Last Update Date | 08/03/2026
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Provider Practice Location Address
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Address Line | 2751 NORTHGATE DR
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City | IOWA CITY
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State | IA
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Zip | 52245-9509
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Country | US
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Telephone | 131-938-4722
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Fax |
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Provider Business Mailing Address
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Address Line | 24248 VIEJAS GRADE RD
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City | DESCANSO
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State | CA
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Zip | 91916-9502
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Country | US
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Telephone | 619-873-7714
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A193102
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License Number State | IA
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