Provider Demographics
NPI:1336857853
Name:BURMAN, ANGELIE DOMINIQUE (LPN)
Entity type:Individual
Prefix:
First Name:ANGELIE
Middle Name:DOMINIQUE
Last Name:BURMAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1541 BORDEAUX RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68522-2416
Mailing Address - Country:US
Mailing Address - Phone:916-699-9055
Mailing Address - Fax:
Practice Address - Street 1:1541 BORDEAUX RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68522-2416
Practice Address - Country:US
Practice Address - Phone:916-699-9055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA709590164X00000X
NE27532164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse