Provider Demographics
NPI:1427137140
Name:BURRIS, VICKIE (NURSE)
Entity type:Individual
Prefix:MS
First Name:VICKIE
Middle Name:
Last Name:BURRIS
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20842 ELAINE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90715-1502
Mailing Address - Country:US
Mailing Address - Phone:562-468-7033
Mailing Address - Fax:
Practice Address - Street 1:20842 ELAINE AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90715-1502
Practice Address - Country:US
Practice Address - Phone:562-468-7033
Practice Address - Fax:323-292-0053
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA362151163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult