Provider Demographics
NPI:1003894742
Name:BURGOS-VIERA, NELSON (CRNA)
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:
Last Name:BURGOS-VIERA
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:NELSON
Other - Middle Name:
Other - Last Name:BURGOS-VIERA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:777 BANNOCK ST
Mailing Address - Street 2:303
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-4507
Mailing Address - Country:US
Mailing Address - Phone:303-436-6000
Mailing Address - Fax:
Practice Address - Street 1:155 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8710
Practice Address - Country:US
Practice Address - Phone:910-715-5809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX561980163W00000X
COC-APN.0000438-C-CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse