Provider Demographics
NPI:1730636341
Name:BURULL, HEATHER (RN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:BURULL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:MARIE
Other - Last Name:TWAMLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25299 DEER VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:RELIANCE
Mailing Address - State:SD
Mailing Address - Zip Code:57569-3000
Mailing Address - Country:US
Mailing Address - Phone:605-245-1576
Mailing Address - Fax:
Practice Address - Street 1:1323 BIA RT 4
Practice Address - Street 2:BOX 200
Practice Address - City:FORT THOMPSON
Practice Address - State:SD
Practice Address - Zip Code:57339
Practice Address - Country:US
Practice Address - Phone:605-245-1576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR047343163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDRN R047343OtherBOARD OF NURSING