Provider Demographics
NPI:1205388303
Name:BURNS, EMILY DELORES (PA)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:DELORES
Last Name:BURNS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:EMILY
Other - Middle Name:DELORES
Other - Last Name:PATERNITI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1836 EATON RD
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:PA
Mailing Address - Zip Code:16415-1930
Mailing Address - Country:US
Mailing Address - Phone:814-860-6917
Mailing Address - Fax:
Practice Address - Street 1:118 E 2ND ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1502
Practice Address - Country:US
Practice Address - Phone:814-877-6000
Practice Address - Fax:814-877-8382
Is Sole Proprietor?:No
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA058664363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant