Provider Demographics
NPI:1023664612
Name:BURNETT, KATHERINE MARIE
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MARIE
Last Name:BURNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4099 MORELAND WAY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95130-1237
Mailing Address - Country:US
Mailing Address - Phone:408-688-1156
Mailing Address - Fax:
Practice Address - Street 1:4099 MORELAND WAY
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95130-1237
Practice Address - Country:US
Practice Address - Phone:408-688-1156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-10
Last Update Date:2019-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide