Individual
MRS. ALTHEA MARIE BURGESS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
158 MAIDA AVE, DEER PARK, NY 11729
(631) 242-0637
Mailing address
158 MAIDA AVE, DEER PARK, NY 11729
(631) 242-0637
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
204219
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02108845
—
NY
Enumeration date
05/28/2008
Last updated
05/28/2008
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