Provider Demographics
NPI:1093892507
Name:BURNS, JACQUELINE (NP)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:BURNS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 TREETOP LN
Mailing Address - Street 2:
Mailing Address - City:WESTAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-4403
Mailing Address - Country:US
Mailing Address - Phone:609-702-8595
Mailing Address - Fax:609-261-7199
Practice Address - Street 1:3111 ROUTE 38 STE 11
Practice Address - Street 2:PMB 120
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-9762
Practice Address - Country:US
Practice Address - Phone:609-261-5755
Practice Address - Fax:609-261-7199
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN08660000363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
2240115000OtherAMERIHEALTH/KEYSTONE/PC
NJ047499Medicare ID - Type Unspecified
P30594Medicare UPIN