=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881808210
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ZIMMIE LYNN BURNATH L.V.N
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13452 CABANA WAY
-----------------------------------------------------
City | VICTORVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92392-6376
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-245-9608
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4280 BEGONIA RD
-----------------------------------------------------
City | PHELAN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92371-6873
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-868-3157
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164X00000X
-----------------------------------------------------
Taxonomy Name | Licensed Vocational Nurse
-----------------------------------------------------
License Number | VN199984
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------