Provider Demographics
NPI:1285407858
Name:BURGESS, ANNETTE MARCIA (NP)
Entity type:Individual
Prefix:MS
First Name:ANNETTE
Middle Name:MARCIA
Last Name:BURGESS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:ANNETTE
Other - Middle Name:MARCIA
Other - Last Name:BURGESS-ROBINSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:18836 114TH DR
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-2611
Mailing Address - Country:US
Mailing Address - Phone:646-241-2766
Mailing Address - Fax:
Practice Address - Street 1:585 SCHENECTADY AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-1822
Practice Address - Country:US
Practice Address - Phone:718-604-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311617363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty