Provider Demographics
NPI:1326252289
Name:BURNS, PAMALA SUE (RN)
Entity Type:Individual
Prefix:MRS
First Name:PAMALA
Middle Name:SUE
Last Name:BURNS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:PAMALA
Other - Middle Name:SUE
Other - Last Name:BURNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:8126 RUNNING FOX RD APT 1B
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-4484
Mailing Address - Country:US
Mailing Address - Phone:567-204-8794
Mailing Address - Fax:
Practice Address - Street 1:8126 RUNNING FOX RD APT 1B
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-4484
Practice Address - Country:US
Practice Address - Phone:567-204-8794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH327334163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2732172Medicaid