Basic Information
Provider Information
NPI: 1134774458
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BURLESON
FirstName: VERONICA
MiddleName: AMBER
NamePrefix: MISS
NameSuffix:  
Credential: RN, BSN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 103 HILLSPRING LN
Address2:  
City: CHAPEL HILL
State: NC
PostalCode: 275164010
CountryCode: US
TelephoneNumber: 9109885016
FaxNumber:  
Practice Location
Address1: 508 FULTON ST
Address2:  
City: DURHAM
State: NC
PostalCode: 277053875
CountryCode: US
TelephoneNumber: 9192860411
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/04/2019
LastUpdateDate: 08/04/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163WM0705X317506NCY Nursing Service ProvidersRegistered NurseMedical-Surgical

No ID Information.


Home