Provider Demographics
NPI:1013229822
Name:BURGESS, YVONNE M (APN)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:M
Last Name:BURGESS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 E WOOD ST
Mailing Address - Street 2:STE 108
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-3752
Mailing Address - Country:US
Mailing Address - Phone:856-692-5600
Mailing Address - Fax:856-692-5601
Practice Address - Street 1:629 E WOOD ST
Practice Address - Street 2:STE 108
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-3752
Practice Address - Country:US
Practice Address - Phone:856-692-5600
Practice Address - Fax:856-692-5601
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-09
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NC04275400364SP0807X, 364SP0809X
PARN350687L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No163W00000XNursing Service ProvidersRegistered Nurse