Provider Demographics
NPI:1093395022
Name:BURRIS, MARGARET CHELSEA ANN (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:CHELSEA ANN
Last Name:BURRIS
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WARREN WAY
Mailing Address - Street 2:
Mailing Address - City:DIX
Mailing Address - State:IL
Mailing Address - Zip Code:62830-1455
Mailing Address - Country:US
Mailing Address - Phone:618-816-2709
Mailing Address - Fax:
Practice Address - Street 1:1 WARREN WAY
Practice Address - Street 2:
Practice Address - City:DIX
Practice Address - State:IL
Practice Address - Zip Code:62830-1455
Practice Address - Country:US
Practice Address - Phone:618-816-2709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.022962363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner