Provider Demographics
NPI:1578778429
Name:BURNS, DEBORAH (CMM)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:
Last Name:BURNS
Suffix:
Gender:F
Credentials:CMM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:# L-3549
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43260-0001
Mailing Address - Country:US
Mailing Address - Phone:740-383-7927
Mailing Address - Fax:740-383-7942
Practice Address - Street 1:1040 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6416
Practice Address - Country:US
Practice Address - Phone:740-383-8080
Practice Address - Fax:740-383-8084
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNMW00378367A00000X
OHCMM-00378163WX0003X
OHRN149462163WX0003X
OHCOA.00378-NM367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2774243Medicaid
NM03891Medicare PIN
OHH209290Medicare PIN