Burt, Derek L

Burt, Derek L is an individual health care provider with primary practice located at 17325 Van Wagoner Rd , Spring Lake MI 49456-9702. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, which is considered as his primary health care specialty. Burt, Derek L can be contacted via phone (616) 847-5145.

Contact Information

Primary practice address
17325 Van Wagoner Rd Spring Lake MI 49456-9702
Phone: (616) 847-5145
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 4704216633 Michigan

Profile Details

NPI number 1811903321
LBN Legal business name Burt, Derek L
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 1st, 2006
Last updated Jun 4th, 2013 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1811903321 NPPES
Michigan Other 500F111460 BCBSM
Michigan MEDICAID 4935522 BCBSM

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