Provider Demographics
NPI:1467019141
Name:BURNETT, CHERYL ANN (FNP)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANN
Last Name:BURNETT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5601 DE SOTO AVE RM 420
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-6798
Mailing Address - Country:US
Mailing Address - Phone:818-719-3079
Mailing Address - Fax:818-719-2075
Practice Address - Street 1:150 COMMONS WAY
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-1910
Practice Address - Country:US
Practice Address - Phone:406-752-2010
Practice Address - Fax:406-752-2047
Is Sole Proprietor?:No
Enumeration Date:2019-05-28
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA570238163WI0500X
MTNUR-APRN-LIC-174308363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy