Provider Demographics
NPI:1689988867
Name:BURDETT, AMY CALDWELL (RN)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:CALDWELL
Last Name:BURDETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6036 HIGHLAND AVE
Mailing Address - Street 2:PO BOX 900
Mailing Address - City:WILLIAMSON
Mailing Address - State:NY
Mailing Address - Zip Code:14589-9731
Mailing Address - Country:US
Mailing Address - Phone:315-589-9668
Mailing Address - Fax:315-589-8315
Practice Address - Street 1:6036 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSON
Practice Address - State:NY
Practice Address - Zip Code:14589-9731
Practice Address - Country:US
Practice Address - Phone:315-589-9668
Practice Address - Fax:315-589-8315
Is Sole Proprietor?:No
Enumeration Date:2010-07-30
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY542254163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
00144114OtherCERTIFIED CASE MANAGER (CCM)