Individual
MARY POWELL BURGESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
418 E MAIN ST, JEFFERSON, NC 28640-8984
(336) 246-9492
Mailing address
PO BOX 5, WEST JEFFERSON, NC 28694-0005
(336) 246-9492
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
643722
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7700417
—
NC
Enumeration date
11/12/2015
Last updated
11/12/2015
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