Provider Demographics
NPI:1134492135
Name:BURNS, JENNIFER LYNN (AP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:BURNS
Suffix:
Gender:F
Credentials:AP
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:BURNS
Other - Last Name:GONNELLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:215 S KING ST
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-2905
Mailing Address - Country:US
Mailing Address - Phone:571-258-0288
Mailing Address - Fax:
Practice Address - Street 1:215 S KING ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-2905
Practice Address - Country:US
Practice Address - Phone:571-258-0288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-22
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3079171100000X
VA0121000792171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist