Provider Demographics
NPI:1619249893
Name:BURNITT, LISA A (ANP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:A
Last Name:BURNITT
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3023 N BALLAS RD STE 500
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2359
Mailing Address - Country:US
Mailing Address - Phone:314-996-7930
Mailing Address - Fax:
Practice Address - Street 1:3023 N BALLAS RD STE 500
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2359
Practice Address - Country:US
Practice Address - Phone:314-996-7930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-02
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO100104363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health