Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | ATP-000929 | AR |
NPI | 1609239474 |
---|---|
Provider Name | Aimee Lee Burrous |
First Address | Fayetteville, AR 72704-6167 |
Second Address | Fayetteville, AR 72704-6167 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2016 |
Last Update Date | 30/03/2016 |