Provider Demographics
NPI:1396554499
Name:BURTON, MARY ELIZABETH (CNA, PHLEBOTOMIST)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:BURTON
Suffix:
Gender:F
Credentials:CNA, PHLEBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 BALD MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-9061
Mailing Address - Country:US
Mailing Address - Phone:307-922-2459
Mailing Address - Fax:
Practice Address - Street 1:53 BALD MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-9061
Practice Address - Country:US
Practice Address - Phone:307-922-2459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY28593376K00000X
WY55181374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty
No374U00000XNursing Service Related ProvidersHome Health Aide