Provider Demographics
NPI:1427016286
Name:BURRIS, MARCUS L (RN)
Entity type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:L
Last Name:BURRIS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11010 W JEFFREY CT
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53225-3825
Mailing Address - Country:US
Mailing Address - Phone:414-461-3152
Mailing Address - Fax:
Practice Address - Street 1:11010 W JEFFREY CT
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225-3825
Practice Address - Country:US
Practice Address - Phone:414-461-3152
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse