Provider Demographics
NPI:1467208678
Name:ROSSUM, BURNETT LEE
Entity type:Individual
Prefix:
First Name:BURNETT
Middle Name:LEE
Last Name:ROSSUM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 HEATHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-3833
Mailing Address - Country:US
Mailing Address - Phone:469-499-7638
Mailing Address - Fax:
Practice Address - Street 1:931 HEATHERWOOD DR
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-3833
Practice Address - Country:US
Practice Address - Phone:469-499-7638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport