Individual
DEIDRA BURGESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
712 MERCER ST STE D, PRINCETON, WV 24740-3114
(304) 431-2443
Mailing address
310 STEELE SAWMILL RD, PRINCETON, WV 24739-5940
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
06/04/2021
Last updated
06/04/2021
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