Provider Demographics
NPI:1265296552
Name:BURGESS, BECKY ANN (PHLEBOTOMIST)
Entity type:Individual
Prefix:
First Name:BECKY
Middle Name:ANN
Last Name:BURGESS
Suffix:
Gender:F
Credentials:PHLEBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5382 HARVEST BREEZE RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-2034
Mailing Address - Country:US
Mailing Address - Phone:818-451-9143
Mailing Address - Fax:
Practice Address - Street 1:5382 HARVEST BREEZE RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-2034
Practice Address - Country:US
Practice Address - Phone:818-451-9143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV47281-AL-0291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory