Provider Demographics
NPI:1851839799
Name:BURNETT, BETTY
Entity Type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:
Last Name:BURNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7020 E RENAISSANCE CT
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70128-2547
Mailing Address - Country:US
Mailing Address - Phone:504-220-5683
Mailing Address - Fax:504-475-5885
Practice Address - Street 1:7020 E RENAISSANCE CT
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70128-2547
Practice Address - Country:US
Practice Address - Phone:504-220-5683
Practice Address - Fax:504-475-5885
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-10
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)