Provider Demographics
NPI:1033707708
Name:BURRUS, MONELLE LARISSA (NP)
Entity type:Individual
Prefix:
First Name:MONELLE
Middle Name:LARISSA
Last Name:BURRUS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2645 NW SKY VISTA CT
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-8604
Mailing Address - Country:US
Mailing Address - Phone:541-728-8262
Mailing Address - Fax:541-203-2022
Practice Address - Street 1:225 SW SCALEHOUSE LOOP UNIT 106
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1272
Practice Address - Country:US
Practice Address - Phone:541-728-8262
Practice Address - Fax:541-203-2202
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-07
Last Update Date:2025-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202100185NP-PP363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care