Provider Demographics
NPI:1699831883
Name:BURGETT, LAURA LYNNE
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:LYNNE
Last Name:BURGETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:356 LAGUNA DR
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-3008
Mailing Address - Country:US
Mailing Address - Phone:510-231-3921
Mailing Address - Fax:510-235-2025
Practice Address - Street 1:2500 BISSELL AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94804-1815
Practice Address - Country:US
Practice Address - Phone:510-231-3921
Practice Address - Fax:510-235-2025
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator