MEDICARE: YVONNE M BURGESS APN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SP0807X	Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist	26NC04275400	NJ
2	364SP0809X	Adult Psychiatric/Mental Health Clinical Nurse Specialist	26NC04275400	NJ
3	163W00000X	Registered Nurse	RN350687L	PA

General Provider Information

NPI Number	:	1013229822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YVONNE M BURGESS APN

Provider Business Mailing Address
First Line	:	629 E WOOD ST
Second Line	:	STE 108
City	:	VINELAND
State	:	NJ
Zip	:	08360-3752
Country	:	US
Telephone Number	:	856-692-5600
Fax Number	:	856-692-5601

Provider Business Practice Location Address
First Line	:	629 E WOOD ST
Second Line	:	STE 108
City	:	VINELAND
State	:	NJ
Zip	:	08360-3752
Country	:	US
Telephone Number	:	856-692-5600
Fax Number	:	856-692-5601

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2010
Last Update Date	:	11/08/2016

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