Provider Demographics
NPI:1164111316
Name:BURGETTE, CARLENE (LPN)
Entity Type:Individual
Prefix:
First Name:CARLENE
Middle Name:
Last Name:BURGETTE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-1403
Mailing Address - Country:US
Mailing Address - Phone:570-309-9797
Mailing Address - Fax:
Practice Address - Street 1:118 MONAHAN AVE
Practice Address - Street 2:
Practice Address - City:DUNMORE
Practice Address - State:PA
Practice Address - Zip Code:18512-1700
Practice Address - Country:US
Practice Address - Phone:570-241-0359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN275287164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse