Provider Demographics
NPI:1447488788
Name:BURNETTE, BRENNA MCCARTNEY (CRNA)
Entity type:Individual
Prefix:
First Name:BRENNA
Middle Name:MCCARTNEY
Last Name:BURNETTE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1139 GRANT ST STE 300
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3707
Mailing Address - Country:US
Mailing Address - Phone:919-698-3960
Mailing Address - Fax:828-274-7407
Practice Address - Street 1:1139 GRANT ST
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3707
Practice Address - Country:US
Practice Address - Phone:919-698-3960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC196402163W00000X
NC082163367500000X
COAPN.0996116-CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8053555Medicaid
NC8053555Medicaid