| NPI | 1669950556 |
|---|---|
| Former Name | STEPHANIE JEAN BURGESS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 201806936NP-PP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN 2063919) |
| 363LF0000X Nurse Practitioner, Family (Licence: MN 10772) | |
| Enumeration Date | 2018-08-01 |
| Last Update Date | 2024-02-15 |