Provider Demographics
NPI:1184054546
Name:NANCY M BURGESS RN MSN ANP-C PC
Entity type:Organization
Organization Name:NANCY M BURGESS RN MSN ANP-C PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BURGESS
Authorized Official - Suffix:
Authorized Official - Credentials:ANP-C
Authorized Official - Phone:541-504-7781
Mailing Address - Street 1:910 SW HIGHWAY 97 STE 104
Mailing Address - Street 2:
Mailing Address - City:MADRAS
Mailing Address - State:OR
Mailing Address - Zip Code:97741-9247
Mailing Address - Country:US
Mailing Address - Phone:541-504-7781
Mailing Address - Fax:
Practice Address - Street 1:910 SW HIGHWAY 97 STE 104
Practice Address - Street 2:
Practice Address - City:MADRAS
Practice Address - State:OR
Practice Address - Zip Code:97741-9247
Practice Address - Country:US
Practice Address - Phone:541-504-7781
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-22
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty