Provider Demographics
NPI:1679088660
Name:BURGESEN, MARIA ARIELLA (CNA, HHA)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:ARIELLA
Last Name:BURGESEN
Suffix:
Gender:F
Credentials:CNA, HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9344 WINDING OAK DR
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-4156
Mailing Address - Country:US
Mailing Address - Phone:651-983-9266
Mailing Address - Fax:
Practice Address - Street 1:4852 HILLVALE AVE N
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:MN
Practice Address - Zip Code:55128-2237
Practice Address - Country:US
Practice Address - Phone:651-983-9266
Practice Address - Fax:651-983-9266
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00908686376K00000X
CA00283861374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide