Individual
ANGELA BURRUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
18780 INTERSTATE 20, CANTON, TX 75103-3593
(903) 567-4841
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6400
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
577526
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
344709601
—
TX
05
—
34479602
—
TX
01
—
75-2616977-001
TRICARE
TX
01
—
775079
MEDICARE
TX
01
—
8055NP
BCBS
TX
01
—
P01454895
RAIL ROAD MEDICARE
TX
01
—
P02207506
MEDICARE RAIL ROAD
TX
Enumeration date
03/21/2014
Last updated
05/20/2019
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