Provider Demographics
NPI:1821288879
Name:BURNETT, MARY (CRNFA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:BURNETT
Suffix:
Gender:F
Credentials:CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 110339
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37222-0339
Mailing Address - Country:US
Mailing Address - Phone:615-831-3711
Mailing Address - Fax:615-831-3713
Practice Address - Street 1:5716 HICKORY PLAZA
Practice Address - Street 2:STE 200
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211
Practice Address - Country:US
Practice Address - Phone:615-831-3711
Practice Address - Fax:615-831-3713
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000041711163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant