Provider Demographics
NPI:1558861526
Name:BURRIS, EDWARD STANLEY II
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:STANLEY
Last Name:BURRIS
Suffix:II
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 S 10TH ST APT 5
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-5565
Mailing Address - Country:US
Mailing Address - Phone:216-450-2673
Mailing Address - Fax:
Practice Address - Street 1:311 S 10TH ST APT 5
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-5565
Practice Address - Country:US
Practice Address - Phone:216-450-2673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-16
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider