Basic Information
| Provider Information | |||||||||
| NPI: | 1164461604 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURT | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3968 FELTON HILL RD SW | ||||||||
| Address2: | STE 100 | ||||||||
| City: | SMYRNA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300823522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7703337888 | ||||||||
| FaxNumber: | 7703337889 | ||||||||
| Practice Location | |||||||||
| Address1: | 6815 NOBLE AVE STE 400 | ||||||||
| Address2: | |||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914056516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189016690 | ||||||||
| FaxNumber: | 8189016699 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2006 | ||||||||
| LastUpdateDate: | 10/01/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | NA07270 | OH | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 3162 | CA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 2380927 | 05 | OH | MEDICAID |