Provider Demographics
NPI:1720064710
Name:BURDETTE, LAWRENCE E (ADC I)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:E
Last Name:BURDETTE
Suffix:
Gender:M
Credentials:ADC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USS NIMITZ (CVN-68)
Mailing Address - Street 2:MEDICAL DEPT, H-DIVISION
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96620
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:USS NIMITZ (CVN-68)
Practice Address - Street 2:MEDICAL DEPT, H-DIVISION
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96620
Practice Address - Country:US
Practice Address - Phone:619-454-0485
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-21
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)