Provider Demographics
NPI:1104123355
Name:BURLINGAME, WILLIAM W (CRNA)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:W
Last Name:BURLINGAME
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:WILLIAM
Other - Middle Name:W
Other - Last Name:BURLINGAME
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1907 WARWICK CIRCLEEAST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-3134
Mailing Address - Country:US
Mailing Address - Phone:903-757-4453
Mailing Address - Fax:
Practice Address - Street 1:1907 WARWICK CIRCLE EAST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-3134
Practice Address - Country:US
Practice Address - Phone:903-757-4453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX736487367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered