Provider Demographics
NPI:1013885433
Name:BURGESS, ELANE (RC-CPSS)
Entity type:Individual
Prefix:
First Name:ELANE
Middle Name:
Last Name:BURGESS
Suffix:
Gender:F
Credentials:RC-CPSS
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 2106
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83403-2106
Mailing Address - Country:US
Mailing Address - Phone:208-523-5319
Mailing Address - Fax:208-523-5627
Practice Address - Street 1:1675 CURLEW DR
Practice Address - Street 2:
Practice Address - City:AMMON
Practice Address - State:ID
Practice Address - Zip Code:83406-4718
Practice Address - Country:US
Practice Address - Phone:208-523-5319
Practice Address - Fax:208-523-5627
Is Sole Proprietor?:No
Enumeration Date:2025-10-27
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker