Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 63139 | WI |
N | 207R00000X | Internist | 4301092230 | MI |
N | 111NI0900X | Internist | 4301092230 | MI |
NPI | 1437310596 |
---|---|
Provider Name | Dr. Mary Elizabeth Burnett |
First Address | Wauwatosa, WI 53226-1409 |
Second Address | Wauwatosa, WI 53226-1415 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2008 |
Last Update Date | 28/01/2015 |