Individual
MICHELLE E BURNHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
402 MAIN ST, VAN BUREN, MO 63965-0000
(573) 323-4253
(573) 323-4465
Mailing address
PO BOX 157, ELLINGTON, MO 63638-0157
(573) 663-2313
(573) 663-2322
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
155361
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1275781254
—
MO
Enumeration date
09/03/2008
Last updated
03/07/2011
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