Provider Demographics
NPI:1386991032
Name:BURNETT, TERI (MD)
Entity type:Individual
Prefix:DR
First Name:TERI
Middle Name:
Last Name:BURNETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TERI
Other - Middle Name:LEE
Other - Last Name:RAISPIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1110 112TH AVE NE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004
Mailing Address - Country:US
Mailing Address - Phone:425-450-0880
Mailing Address - Fax:425-450-0883
Practice Address - Street 1:1110 112TH AVE NE
Practice Address - Street 2:SUITE 150
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004
Practice Address - Country:US
Practice Address - Phone:425-450-0880
Practice Address - Fax:425-450-0883
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00032288208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery