Individual
MRS. STACEY A BURT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1376 RIVER RD, BINGHAMTON, NY 13901-5702
(607) 821-8739
Mailing address
1376 RIVER RD, BINGHAMTON, NY 13901-5702
(607) 821-8739
Taxonomy
Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
Primary
402391-1
NY
163WS0200X
School Registered Nurse
402391-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1115202504
—
NY
Enumeration date
10/17/2011
Last updated
05/09/2023
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