Provider Demographics
NPI:1841624079
Name:BURT, STUART V (RN)
Entity type:Individual
Prefix:MR
First Name:STUART
Middle Name:V
Last Name:BURT
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10112 BARNES LN S
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98444-4136
Mailing Address - Country:US
Mailing Address - Phone:253-973-3358
Mailing Address - Fax:253-302-4331
Practice Address - Street 1:10112 BARNES LN S
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-4136
Practice Address - Country:US
Practice Address - Phone:253-973-3358
Practice Address - Fax:253-302-4331
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-23
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60303093163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse