Provider Demographics
NPI:1124046115
Name:BURLESON, JEANETTE HOWELL (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:JEANETTE
Middle Name:HOWELL
Last Name:BURLESON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:417 PARK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-2831
Mailing Address - Country:US
Mailing Address - Phone:704-986-4495
Mailing Address - Fax:704-983-3690
Practice Address - Street 1:417 PARK RIDGE RD
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-2831
Practice Address - Country:US
Practice Address - Phone:704-986-4495
Practice Address - Fax:704-983-3690
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC048939367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered