Provider Demographics
NPI:1730658147
Name:BURNETTE, SUSAN (FNP-C)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:BURNETTE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 W 3RD ST LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:IL
Mailing Address - Zip Code:61081-3510
Mailing Address - Country:US
Mailing Address - Phone:815-564-1999
Mailing Address - Fax:
Practice Address - Street 1:15 W 3RD ST LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:IL
Practice Address - Zip Code:61081-3510
Practice Address - Country:US
Practice Address - Phone:815-564-1999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209018419363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily