Individual
LACIE SHAE BURGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
400 SOUTH OAK STREET, RANDOLPH MEDICAL CENTER, WINCHESTER, IN 47394
(765) 584-6600
(765) 584-6503
Mailing address
1100 REID PARKWAY, MEDICAL STAFF SERVICES, RICHMOND, IN 47374
(765) 584-6600
(765) 584-6503
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71007164A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
224040161
MEDICARE PTAN
IN
01
—
P02622733
RAILROAD PTAN
IN
Enumeration date
03/04/2017
Last updated
08/28/2024
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