Provider Demographics
NPI:1699044958
Name:BURNETT, ANTHONY LLOYD (RN)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:LLOYD
Last Name:BURNETT
Suffix:
Gender:M
Credentials:RN
Other - Prefix:MR
Other - First Name:ANTHONY
Other - Middle Name:LLOYD
Other - Last Name:BURNETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:2 TERRITORY RD
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:NY
Mailing Address - Zip Code:13421-9304
Mailing Address - Country:US
Mailing Address - Phone:315-829-8701
Mailing Address - Fax:
Practice Address - Street 1:2 TERRITORY RD
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-9304
Practice Address - Country:US
Practice Address - Phone:315-829-8701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211553163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse