MEDICARE: KANEISHA RAE DEBURGO DNP, APRN, FNP-BC

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	363LP2300X	Primary Care Nurse Practitioner	APRN02687	RI
2	363LF0000X	Family Nurse Practitioner	RN2280848	MA

General Provider Information

NPI Number	:	1952955023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KANEISHA RAE DEBURGO DNP, APRN, FNP-BC

Provider Business Mailing Address
First Line	:	600 OLD SOMERSET AVE
Second Line	:
City	:	NORTH DIGHTON
State	:	MA
Zip	:	02764-1866
Country	:	US
Telephone Number	:	508-824-7557
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 OLD SOMERSET AVE
Second Line	:
City	:	NORTH DIGHTON
State	:	MA
Zip	:	02764-1866
Country	:	US
Telephone Number	:	508-824-7557
Fax Number	:

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

Provider Enumeration Date	:	07/27/2019
Last Update Date	:	05/31/2023

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