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Individual

LAURA K. BURGESON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
1986 W HAYDEN AVE, HAYDEN, ID 83835-7412
(208) 762-7760
(208) 762-7740
Mailing address
1986 W HAYDEN AVE, HAYDEN, ID 83835-7412
(208) 762-7760
(208) 762-7740

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA533
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1370136
MEDICARE GROUP PTAN
01
16666921
MEDICARE PTAN
05
7144785
WA
05
807116700
ID
05
8080036
ID
05
8421174
WA
Enumeration date
04/20/2006
Last updated
06/16/2021
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