Provider Demographics
NPI:1417144833
Name:BURGESS, DELORES MAE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:DELORES
Middle Name:MAE
Last Name:BURGESS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:DELORES
Other - Middle Name:
Other - Last Name:SENTERFITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2815 S HAMPTON RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75224-2329
Mailing Address - Country:US
Mailing Address - Phone:214-333-7333
Mailing Address - Fax:214-333-7342
Practice Address - Street 1:2815 S HAMPTON RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-2329
Practice Address - Country:US
Practice Address - Phone:214-333-7333
Practice Address - Fax:214-333-7342
Is Sole Proprietor?:No
Enumeration Date:2007-09-30
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX641179363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily