Provider Demographics
NPI:1194131847
Name:BURGESS, CORA C (APN)
Entity type:Individual
Prefix:
First Name:CORA
Middle Name:C
Last Name:BURGESS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:CORA
Other - Middle Name:C
Other - Last Name:DALLETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:2500 ENGLISH CREEK AVE STE 222
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-5598
Mailing Address - Country:US
Mailing Address - Phone:609-909-0200
Mailing Address - Fax:
Practice Address - Street 1:2500 ENGLISH CREEK AVE
Practice Address - Street 2:BUILDING 200 SUITE 222
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-5549
Practice Address - Country:US
Practice Address - Phone:609-382-5066
Practice Address - Fax:609-909-0267
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00507800363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health