Provider Demographics
NPI:1386662450
Name:BURNAM, DARENE A (NP)
Entity Type:Individual
Prefix:DR
First Name:DARENE
Middle Name:A
Last Name:BURNAM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:DR
Other - First Name:DARENE
Other - Middle Name:A
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:316 W BOONE AVE
Mailing Address - Street 2:SUITE 757
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2354
Mailing Address - Country:US
Mailing Address - Phone:509-868-0876
Mailing Address - Fax:509-385-0670
Practice Address - Street 1:316 W BOONE AVE
Practice Address - Street 2:SUITE 757
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2354
Practice Address - Country:US
Practice Address - Phone:509-868-0876
Practice Address - Fax:509-385-0670
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11372363L00000X
WAAP60507003363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
95-4372419OtherGROUP TAX ID
95-4372419OtherGROUP TAX ID
95-4372419OtherGROUP TAX ID
P18145Medicare UPIN