Provider Demographics
NPI:1285003459
Name:CHARLES W BURNS, MSN, NP IN FAMILY HEALTH PLLC
Entity Type:Organization
Organization Name:CHARLES W BURNS, MSN, NP IN FAMILY HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIMARY PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:716-266-6664
Mailing Address - Street 1:6435 WEBSTER RD
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1835
Mailing Address - Country:US
Mailing Address - Phone:716-266-6664
Mailing Address - Fax:716-266-6665
Practice Address - Street 1:6435 WEBSTER RD
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1835
Practice Address - Country:US
Practice Address - Phone:716-266-6664
Practice Address - Fax:716-266-6665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-17
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332858363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPO7736Medicare UPIN