Provider Demographics
NPI:1144771361
Name:BURNS, MICHAEL (CRNP)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:BURNS
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 CREAMERY WAY STE 400
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2551
Mailing Address - Country:US
Mailing Address - Phone:610-594-7590
Mailing Address - Fax:610-594-2625
Practice Address - Street 1:217 REECEVILLE RD STE A
Practice Address - Street 2:
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320-1572
Practice Address - Country:US
Practice Address - Phone:610-269-9448
Practice Address - Fax:610-594-2625
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016916363LF0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily