Provider Demographics
NPI:1578882999
Name:BURNS, JADE ANDREA (PHD,RN,CPNP-PC)
Entity Type:Individual
Prefix:MRS
First Name:JADE
Middle Name:ANDREA
Last Name:BURNS
Suffix:
Gender:F
Credentials:PHD,RN,CPNP-PC
Other - Prefix:
Other - First Name:JADE
Other - Middle Name:ANDREA
Other - Last Name:CURRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13901 E JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48215-2720
Mailing Address - Country:US
Mailing Address - Phone:313-897-7700
Mailing Address - Fax:313-897-5991
Practice Address - Street 1:111 W 7 MILE RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48203-1968
Practice Address - Country:US
Practice Address - Phone:313-369-2600
Practice Address - Fax:313-369-2477
Is Sole Proprietor?:No
Enumeration Date:2010-05-25
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704256460363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3025602Medicaid