MEDICARE: KATHRYN BURGESS CRNA

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	367500000X	Certified Registered Nurse Anesthetist	ARNP9162812	FL

General Provider Information

NPI Number	:	1225139413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN BURGESS CRNA

Provider Business Mailing Address
First Line	:	4625 SW 13TH AVE
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33914-6330
Country	:	US
Telephone Number	:	239-770-2820
Fax Number	:

Provider Business Practice Location Address
First Line	:	665 DEL PRADO BLVD S
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-5630
Country	:	US
Telephone Number	:	239-770-7322
Fax Number	:

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

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	07/08/2007

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