Provider Demographics
NPI:1285486274
Name:BURGESS, ELIZABETH (RN-PMH-BC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BURGESS
Suffix:
Gender:F
Credentials:RN-PMH-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2585 LONDON LN
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08361-7755
Mailing Address - Country:US
Mailing Address - Phone:856-853-2020
Mailing Address - Fax:856-221-4262
Practice Address - Street 1:17 W RED BANK AVE STE 302B
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-1630
Practice Address - Country:US
Practice Address - Phone:856-853-2020
Practice Address - Fax:856-221-4262
Is Sole Proprietor?:No
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO11193500163W00000X, 163WC0400X, 163WP0807X, 163WP0809X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult