Provider Demographics
NPI:1285621201
Name:BURROUGHS, CHARLES CLIFTON (NP)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:CLIFTON
Last Name:BURROUGHS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:999 S MARINE DR
Mailing Address - Street 2:ALUPANG BEACH TOWER #401
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-3415
Mailing Address - Country:US
Mailing Address - Phone:671-649-9666
Mailing Address - Fax:
Practice Address - Street 1:NAVAL HOSPITAL GUAM
Practice Address - Street 2:FARENHOLT AVE BLDG K-1
Practice Address - City:AGANA HEIGHTS
Practice Address - State:GU
Practice Address - Zip Code:96910
Practice Address - Country:US
Practice Address - Phone:671-644-9054
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024164796363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily