Provider Demographics
NPI:1225138597
Name:BURNS, HOPE ELLEN (PAC)
Entity Type:Individual
Prefix:
First Name:HOPE
Middle Name:ELLEN
Last Name:BURNS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-4807
Mailing Address - Country:US
Mailing Address - Phone:401-305-5280
Mailing Address - Fax:401-305-5285
Practice Address - Street 1:1145 MAIN ST
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-4807
Practice Address - Country:US
Practice Address - Phone:401-305-5280
Practice Address - Fax:401-305-5285
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI00290363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P05156Medicare UPIN