Provider Demographics
NPI:1275732877
Name:BURNS, PAMELA SUE (LPN)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:SUE
Last Name:BURNS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8141 STARRY NIGHT DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45327-8713
Mailing Address - Country:US
Mailing Address - Phone:937-286-4611
Mailing Address - Fax:
Practice Address - Street 1:8141 STARRY NIGHT DR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:OH
Practice Address - Zip Code:45327-8713
Practice Address - Country:US
Practice Address - Phone:937-286-4611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN076055164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2732538Medicaid