Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | RN247259 | GA |
N | 363LG0600X | Nurse Practitioner - Gerontology | RN247259 | GA |
NPI | 1023694437 |
---|---|
Provider Name | Ms. Tonecesa Burtton |
First Address | Lithonia, GA 30058-3518 |
Second Address | Lithonia, GA 30058-3518 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2021 |
Last Update Date | 24/03/2021 |