Provider Demographics
NPI:1518191568
Name:BURNS, CAROL ELAINE (RN)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ELAINE
Last Name:BURNS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 BELLAIRE AVE
Mailing Address - Street 2:#103
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45420-1765
Mailing Address - Country:US
Mailing Address - Phone:937-610-3656
Mailing Address - Fax:
Practice Address - Street 1:128 BELLAIRE AVE
Practice Address - Street 2:#103
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45420-1765
Practice Address - Country:US
Practice Address - Phone:937-610-3656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN257039163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse