Provider Demographics
NPI:1467409565
Name:BURTON, PATRICIA DAVIS (FNP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:DAVIS
Last Name:BURTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 STANDARD WAREHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:LUGOFF
Mailing Address - State:SC
Mailing Address - Zip Code:29078-9670
Mailing Address - Country:US
Mailing Address - Phone:803-438-6023
Mailing Address - Fax:803-438-3671
Practice Address - Street 1:116 STANDARD WAREHOUSE RD
Practice Address - Street 2:
Practice Address - City:LUGOFF
Practice Address - State:SC
Practice Address - Zip Code:29078-9670
Practice Address - Country:US
Practice Address - Phone:803-438-6023
Practice Address - Fax:803-438-3671
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1353363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P30299Medicare UPIN