Provider Demographics
NPI:1699929869
Name:BURNETT, CAROLYN A (RN)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:A
Last Name:BURNETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 THELMA DR # 422
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-2325
Mailing Address - Country:US
Mailing Address - Phone:307-259-1076
Mailing Address - Fax:307-333-0221
Practice Address - Street 1:601 N 8 MILE RD
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604-9620
Practice Address - Country:US
Practice Address - Phone:307-259-1076
Practice Address - Fax:307-333-0221
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY16660163W00000X, 163WH0200X, 163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy