Individual
KOLLEEN BURNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5409 AVENUE O, FORT MADISON, IA 52627-9601
(319) 376-2134
(319) 376-2188
Mailing address
5409 AVENUE O, FORT MADISON, IA 52627-9601
(319) 376-2134
(319) 376-2188
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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