Provider Demographics
NPI:1043030745
Name:BURNETT, SARITA RENAE
Entity type:Individual
Prefix:
First Name:SARITA
Middle Name:RENAE
Last Name:BURNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SARITA
Other - Middle Name:RENAE
Other - Last Name:BURNETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2708 E 10TH ST STE 27082708
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-3149
Mailing Address - Country:US
Mailing Address - Phone:252-364-9789
Mailing Address - Fax:252-364-9789
Practice Address - Street 1:2708 E 10TH ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-3149
Practice Address - Country:US
Practice Address - Phone:252-364-9789
Practice Address - Fax:252-364-9789
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-16
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC224P00000X
335E00000X
NC335E00000X224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No335E00000XSuppliersProsthetic/Orthotic Supplier