Provider Demographics
NPI:1821091638
Name:BURNAP, TERESA K (DPM)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:K
Last Name:BURNAP
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 N 83RD ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-2080
Mailing Address - Country:US
Mailing Address - Phone:402-483-4485
Mailing Address - Fax:402-483-5372
Practice Address - Street 1:1150 N 83RD ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-2080
Practice Address - Country:US
Practice Address - Phone:402-483-4485
Practice Address - Fax:402-483-5372
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE238213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47083655807Medicaid
NE27-00188OtherUNITED HEALTHCARE ID
NE2587OtherBLUE CROSS BLUE SHIELD ID
NE2587OtherBLUE CROSS BLUE SHIELD ID
NE273998Medicare PIN
NEU43078Medicare UPIN