Individual
MRS. PAMELA EILENE BURGESS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
10998 KK HWY, CROCKER, MO 65452
(573) 291-3870
Mailing address
10998 KK HWY, P.O. BOX 285, CROCKER, MO 65452
(573) 291-3870
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
052397
MO
Other
Enumeration date
11/02/2010
Last updated
11/02/2010
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