Provider Demographics
NPI:1699773945
Name:BURNETT, BRUCE L (ARNPC)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:L
Last Name:BURNETT
Suffix:
Gender:M
Credentials:ARNPC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7147 VISTA DR STE 150
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-9313
Mailing Address - Country:US
Mailing Address - Phone:515-875-9925
Mailing Address - Fax:515-875-9923
Practice Address - Street 1:5950 UNIVERSITY AVE
Practice Address - Street 2:STE 105
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266
Practice Address - Country:US
Practice Address - Phone:515-875-9070
Practice Address - Fax:515-875-9071
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IAA054714363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0685214Medicaid
IA47420OtherBLUE SHIELD OF IA
IA0685214Medicaid
IA168521Medicare ID - Type UnspecifiedMEDICARE RURAL HEALTH