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NPI Code Detail

MEDICARE: ANNIE BURT

MEDICARE: ANNIE BURT
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1144172057
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNIE BURT
Provider Business Mailing Address
First Line : 4055 SW GARDEN HOME RD
Second Line :
City : PORTLAND
State : OR
Zip : 97219-3664
Country : US
Telephone Number : 509-906-3153
Fax Number : 833-968-1900
Provider Business Practice Location Address
First Line : 4055 SW GARDEN HOME RD
Second Line :
City : PORTLAND
State : OR
Zip : 97219-3664
Country : US
Telephone Number : 509-906-3153
Fax Number : 833-968-1900
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/12/2026
Last Update Date : 02/18/2026

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Directions to “ ANNIE BURT ” Practice Location

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