Basic Information
| Provider Information | |||||||||
| NPI: | 1306446729 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURMEISTER | ||||||||
| FirstName: | EMILY | ||||||||
| MiddleName: | LAUREN | ||||||||
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| Credential: | CBT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12507 NE 183RD ST APT 301 | ||||||||
| Address2: | |||||||||
| City: | BOTHELL | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980119324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535795468 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6021 244TH ST SW STE 400 | ||||||||
| Address2: | |||||||||
| City: | MOUNTLAKE TERRACE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980435426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252459940 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2020 | ||||||||
| LastUpdateDate: | 10/26/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | CB60981080 | WA | Y |
No ID Information.