Provider Demographics
NPI:1194971861
Name:BURNETTE, GAYLE BARLEY (RN, BSN)
Entity type:Individual
Prefix:MRS
First Name:GAYLE
Middle Name:BARLEY
Last Name:BURNETTE
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:452 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-1893
Mailing Address - Country:US
Mailing Address - Phone:434-728-0478
Mailing Address - Fax:434-836-2826
Practice Address - Street 1:452 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-1893
Practice Address - Country:US
Practice Address - Phone:434-728-0478
Practice Address - Fax:434-836-2826
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001093048171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator