Provider Demographics
NPI:1225028665
Name:BURR, ALICIA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:
Last Name:BURR
Suffix:
Gender:F
Credentials:APRN
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 208017
Mailing Address - Street 2:333 CEDAR STREET
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06520-8017
Mailing Address - Country:US
Mailing Address - Phone:203-737-3333
Mailing Address - Fax:203-737-8833
Practice Address - Street 1:333 CEDAR STREET
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06520-8017
Practice Address - Country:US
Practice Address - Phone:203-737-3333
Practice Address - Fax:203-737-8833
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002376363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P22551Medicare UPIN