Provider Demographics
NPI:1942397310
Name:BURROWS, LAVONNE M (RN BC M-SCNS)
Entity Type:Individual
Prefix:MRS
First Name:LAVONNE
Middle Name:M
Last Name:BURROWS
Suffix:
Gender:F
Credentials:RN BC M-SCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5342 S HOLLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65810-2628
Mailing Address - Country:US
Mailing Address - Phone:417-894-6592
Mailing Address - Fax:
Practice Address - Street 1:101 SKAGGS RD STE 302
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-2062
Practice Address - Country:US
Practice Address - Phone:417-334-8288
Practice Address - Fax:417-334-6966
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO076456364SM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO126510OtherBLUE CROSS BLUE SHIELD
MO1942397310Medicaid
569325OtherHEALTHLINK
MO000083045OtherMEDICARE PTAN
500024671OtherRAILROAD MEDICARE
500024671OtherRAILROAD MEDICARE
MO1942397310Medicaid
MO126510OtherBLUE CROSS BLUE SHIELD