Provider Demographics
NPI:1144595604
Name:BURTON, WENDY LYNN
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:LYNN
Last Name:BURTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 COMBS LN
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-3552
Mailing Address - Country:US
Mailing Address - Phone:707-652-4699
Mailing Address - Fax:
Practice Address - Street 1:333 HEGENBERGER RD STE 600
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94621-1462
Practice Address - Country:US
Practice Address - Phone:510-383-1663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker