Provider Demographics
NPI:1831669175
Name:BURNETT, AMBER LENAY (RN)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:LENAY
Last Name:BURNETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:AMBER
Other - Middle Name:LENAY
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:19650 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-1624
Mailing Address - Country:US
Mailing Address - Phone:216-673-0170
Mailing Address - Fax:
Practice Address - Street 1:19650 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-1624
Practice Address - Country:US
Practice Address - Phone:216-673-0170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-29
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704306959163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse