MEDICARE: LAUREN BURNETT FNP

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	364SP0200X	Pediatric Clinical Nurse Specialist	AP133407	TX
2	363L00000X	Nurse Practitioner	AP133407	TX

General Provider Information

NPI Number	:	1467983122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN BURNETT FNP

Provider Business Mailing Address
First Line	:	1907 SOUTHWEST FWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77098-4803
Country	:	US
Telephone Number	:	713-806-4742
Fax Number	:

Provider Business Practice Location Address
First Line	:	1907 SOUTHWEST FWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77098-4803
Country	:	US
Telephone Number	:	832-630-8529
Fax Number	:

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

Provider Enumeration Date	:	03/24/2017
Last Update Date	:	11/25/2018

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