Provider Demographics
NPI:1124314133
Name:BURTON, NICOLE LEANN (DVM)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:LEANN
Last Name:BURTON
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2972 OLD OLYMPIC HWY
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-9121
Mailing Address - Country:US
Mailing Address - Phone:360-457-3842
Mailing Address - Fax:
Practice Address - Street 1:2972 OLD OLYMPIC HWY
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-9121
Practice Address - Country:US
Practice Address - Phone:360-457-3842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVT60198876174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAVT60198876OtherVETERINARY LICENSE NUMBER