Individual
LAURA JEAN BURNSIDE-MCELLIGOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1890 WAITE ST, STE 1, NORTH BEND, OR 97459-1229
(541) 756-6232
(541) 756-6234
Mailing address
1890 WAITE ST, STE 1, NORTH BEND, OR 97459-1229
(541) 756-6232
(541) 756-6234
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
081046951RN
OR
363LF0000X
Family Nurse Practitioner
Primary
200850064NP FNP-PP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
213342
—
OR
05
—
500617181
—
OR
01
—
R163722
MEDICARE PTAN
—
Enumeration date
07/18/2008
Last updated
06/15/2012
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