Provider Demographics
NPI:1114179793
Name:BURGESS, ANN WOLBERT (DNSC, RN)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:WOLBERT
Last Name:BURGESS
Suffix:
Gender:F
Credentials:DNSC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WEST NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02465-2512
Mailing Address - Country:US
Mailing Address - Phone:617-965-6261
Mailing Address - Fax:
Practice Address - Street 1:228 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:WEST NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02465-2512
Practice Address - Country:US
Practice Address - Phone:617-965-6261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN71027364SP0808X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health