Provider Demographics
NPI:1578805800
Name:BURGNER, RONALD LINN
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:LINN
Last Name:BURGNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26221 5TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-7662
Mailing Address - Country:US
Mailing Address - Phone:425-478-5847
Mailing Address - Fax:425-328-1613
Practice Address - Street 1:26221 5TH AVE NE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-7662
Practice Address - Country:US
Practice Address - Phone:425-478-5847
Practice Address - Fax:425-328-1613
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-25
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA305602320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities