Provider Demographics
NPI:1326695867
Name:BURGESS, RACHEL ANNE (NP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ANNE
Last Name:BURGESS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:RACHEL
Other - Middle Name:ANNE
Other - Last Name:UMLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11160 WJ PRESLEY PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49401-8075
Mailing Address - Country:US
Mailing Address - Phone:616-252-3900
Mailing Address - Fax:616-252-3920
Practice Address - Street 1:11160 WJ PRESLEY PKWY STE 100
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:MI
Practice Address - Zip Code:49401-8075
Practice Address - Country:US
Practice Address - Phone:616-252-3900
Practice Address - Fax:616-252-3920
Is Sole Proprietor?:No
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704289925207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine