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Individual
KOLLEEN BURNETT
Active
Individual
KOLLEEN BURNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
036-105825
IL
208000000X
Pediatrics Physician
Primary
4236
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036105825
—
IL
01
—
132131665
WELLMARK BLUE CROSS BLUE SHIELD
IA
05
—
1326131665
—
IA
Enumeration date
10/01/2006
Last updated
02/24/2012
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