Provider Demographics
NPI:1346533023
Name:BURGESS, CATHLEEN ANGELA (RN)
Entity Type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:ANGELA
Last Name:BURGESS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USAG-J UNIT 45013
Mailing Address - Street 2:BOX 2746
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96338
Mailing Address - Country:US
Mailing Address - Phone:315-263-5259
Mailing Address - Fax:315-263-3866
Practice Address - Street 1:USAG-J UNIT 45013
Practice Address - Street 2:BOX 2746
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96338
Practice Address - Country:US
Practice Address - Phone:315-263-5259
Practice Address - Fax:315-263-3866
Is Sole Proprietor?:No
Enumeration Date:2011-05-27
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-075128163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care