Provider Demographics
NPI:1083607246
Name:BURTON, HEIDI (CRNA)
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:
Last Name:BURTON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:469-291-3369
Mailing Address - Fax:214-645-0078
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390
Practice Address - Country:US
Practice Address - Phone:214-648-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA601262163W00000X
CA2868367500000X
TX127909367500000X
TXAP127909367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0145284OtherLABOR AND INDUSTRIES
WA180041735OtherRAILROAD MEDICARE
ID805058100OtherPUBLIC ASSISTANCE
WAP00178865OtherRAILROAD MEDICARE
WA9629155Medicaid
WA910852217OtherTAX ID NUMBER
WAS28026Medicare UPIN
WA910852217OtherTAX ID NUMBER
ID805058100OtherPUBLIC ASSISTANCE
WAG8850730Medicare PIN
WA0145284OtherLABOR AND INDUSTRIES
WA180041735OtherRAILROAD MEDICARE
WAG8850731Medicare PIN
WAG8850727Medicare PIN