Provider Demographics
NPI:1538927736
Name:BURGESS, DANIEL ALLEN
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:ALLEN
Last Name:BURGESS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 LITTLE COAL RIVER RD
Mailing Address - Street 2:
Mailing Address - City:ALUM CREEK
Mailing Address - State:WV
Mailing Address - Zip Code:25003-9748
Mailing Address - Country:US
Mailing Address - Phone:304-786-4996
Mailing Address - Fax:
Practice Address - Street 1:230 LITTLE COAL RIVER RD
Practice Address - Street 2:
Practice Address - City:ALUM CREEK
Practice Address - State:WV
Practice Address - Zip Code:25003-9748
Practice Address - Country:US
Practice Address - Phone:304-786-4996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-12
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant