Provider Demographics
NPI:1225153448
Name:BURNS, GERALD (CNP, ACRN, MSN, CS)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:BURNS
Suffix:
Gender:M
Credentials:CNP, ACRN, MSN, CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 E MAPLE RD
Mailing Address - Street 2:SUITE 400 - CREDENTIALING
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1138
Mailing Address - Country:US
Mailing Address - Phone:313-745-4525
Mailing Address - Fax:313-577-3223
Practice Address - Street 1:3901 CHRYSLER DR
Practice Address - Street 2:SUITE 4A
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2167
Practice Address - Country:US
Practice Address - Phone:313-745-4525
Practice Address - Fax:313-577-3777
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704111484363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P32180030Medicare PIN