MEDICARE: CHERYL LEE BURLEY CNP

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	363L00000X	Nurse Practitioner	4704126846	MI
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	4704126846	MI
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP8175	AZ
4	363LF0000X	Family Nurse Practitioner	AP8176	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760482327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL LEE BURLEY CNP

Provider Business Mailing Address
First Line	:	PO BOX 178
Second Line	:
City	:	PAW PAW
State	:	MI
Zip	:	49079-0178
Country	:	US
Telephone Number	:	269-657-2550
Fax Number	:	269-657-2285

Provider Business Practice Location Address
First Line	:	1743 SYCAMORE AVE
Second Line	:
City	:	KINGMAN
State	:	AZ
Zip	:	86409-0927
Country	:	US
Telephone Number	:	269-423-7028
Fax Number	:	269-423-8282

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

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	10/15/2015

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