Provider Demographics
NPI:1619109287
Name:BURNETT, STEPHENYE (RN, NP)
Entity type:Individual
Prefix:
First Name:STEPHENYE
Middle Name:
Last Name:BURNETT
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5512 MOORHOUSE CT
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95842-4249
Mailing Address - Country:US
Mailing Address - Phone:916-607-8131
Mailing Address - Fax:
Practice Address - Street 1:5512 MOORHOUSE CT
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95842-4249
Practice Address - Country:US
Practice Address - Phone:916-607-8131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18945363LF0000X
CA451605163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1619109287Medicaid