Individual
LANCE R BURRELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
EXIT 102 11/2 MI. SOUTH I-40, ACOMA-CANONCITO-LAGUNA INDIAN, SAN FIDEL, NM 87049-0130
(505) 552-5300
Mailing address
PO BOX 130, SAN FIDEL, NM 87049-0130
(505) 552-5300
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
5653727-4405
UT
363LF0000X
Family Nurse Practitioner
Primary
AP4694
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
H3451
—
NM
Enumeration date
04/26/2006
Last updated
09/02/2014
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