Provider Demographics
NPI:1558511550
Name:BURTON, SYBRENIA LYNN (RN, BSN)
Entity Type:Individual
Prefix:
First Name:SYBRENIA
Middle Name:LYNN
Last Name:BURTON
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1816 MONTGOMERY CT
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-7485
Mailing Address - Country:US
Mailing Address - Phone:260-493-1457
Mailing Address - Fax:
Practice Address - Street 1:1816 MONTGOMERY CT
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-7485
Practice Address - Country:US
Practice Address - Phone:260-493-1457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28146655A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse