Provider Demographics
NPI:1326883547
Name:BURNETT, ISABELLA
Entity type:Individual
Prefix:
First Name:ISABELLA
Middle Name:
Last Name:BURNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2103 HAGGINS ST
Mailing Address - Street 2:
Mailing Address - City:TUSKEGEE INST
Mailing Address - State:AL
Mailing Address - Zip Code:36088-3024
Mailing Address - Country:US
Mailing Address - Phone:773-817-2016
Mailing Address - Fax:
Practice Address - Street 1:2103 HAGGINS ST
Practice Address - Street 2:
Practice Address - City:TUSKEGEE INST
Practice Address - State:AL
Practice Address - Zip Code:36088-3024
Practice Address - Country:US
Practice Address - Phone:773-817-2016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No171400000XOther Service ProvidersHealth & Wellness Coach