Provider Demographics
NPI:1396189189
Name:BURRUSS, MAMIE (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:MAMIE
Middle Name:
Last Name:BURRUSS
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 W CAPITOL AVE STE 1242
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72201-3405
Mailing Address - Country:US
Mailing Address - Phone:888-376-2643
Mailing Address - Fax:888-376-2643
Practice Address - Street 1:425 W CAPITOL AVE STE 1242
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72201-3405
Practice Address - Country:US
Practice Address - Phone:888-376-2643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-23
Last Update Date:2023-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT099.0134038175F00000X
AR089171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No175F00000XOther Service ProvidersNaturopath