Provider Demographics
NPI:1043520422
Name:BURNETT, NATALIE (NP)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:BURNETT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MYRTLE LN
Mailing Address - Street 2:
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-5722
Mailing Address - Country:US
Mailing Address - Phone:631-356-6766
Mailing Address - Fax:
Practice Address - Street 1:1 MYRTLE LN
Practice Address - Street 2:
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-5722
Practice Address - Country:US
Practice Address - Phone:631-356-6766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-19
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF309201363L00000X
NY582510163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse