Provider Demographics
NPI:1780232272
Name:BURNETT, BILLIE JO (IRI)
Entity Type:Individual
Prefix:
First Name:BILLIE
Middle Name:JO
Last Name:BURNETT
Suffix:
Gender:F
Credentials:IRI
Other - Prefix:
Other - First Name:BILLIE
Other - Middle Name:JO
Other - Last Name:BURNETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:IRI
Mailing Address - Street 1:1429 N 1200 W
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-2449
Mailing Address - Country:US
Mailing Address - Phone:801-420-0089
Mailing Address - Fax:801-607-1279
Practice Address - Street 1:1429 N 1200 W
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-2449
Practice Address - Country:US
Practice Address - Phone:801-420-0089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA151526175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist