| Doctor Name: | MARYLOU BURGESS |
| NPI Number: | 1215043757 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | R024901 |
| Business Practice Address: | 11 Hills Beach Rd Biddeford, ME - 040059526 |
| Business Phone Number: | 2076022358 |
| Business Fax Number: | 2076025904 |
| Mailing Address: | Po Box 284, BRATTLEBORO |
| State: | VT |
| Postal Code: | 053020284 |
| Phone Number: | 2077842554 |
| Fax Number: | 2077775363 |
| NPI Enumeration Date: | 08/21/2006 |
| NPI Last Update Date: | 02/05/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | R024901 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | ME |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |