Provider Demographics
NPI:1174700041
Name:BURD, CARRIE P (LPN)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:P
Last Name:BURD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 OSWEGO ST
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-5029
Mailing Address - Country:US
Mailing Address - Phone:315-453-1459
Mailing Address - Fax:
Practice Address - Street 1:902 OSWEGO ST
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-5029
Practice Address - Country:US
Practice Address - Phone:315-453-1459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY250838-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse