Provider Demographics
NPI:1245473024
Name:BURMEISTER, STACY LYNN
Entity type:Individual
Prefix:MS
First Name:STACY
Middle Name:LYNN
Last Name:BURMEISTER
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 1:644 E SHERWOOD HILLS DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-8165
Mailing Address - Country:US
Mailing Address - Phone:812-345-2468
Mailing Address - Fax:
Practice Address - Street 1:644 E SHERWOOD HILLS DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-8165
Practice Address - Country:US
Practice Address - Phone:812-345-2468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-09
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker