Provider Demographics
NPI:1669482410
Name:BURHENN, EDA M (CRNP)
Entity Type:Individual
Prefix:MS
First Name:EDA
Middle Name:M
Last Name:BURHENN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1781 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-1256
Mailing Address - Country:US
Mailing Address - Phone:814-454-5896
Mailing Address - Fax:814-456-0037
Practice Address - Street 1:1781 W 26TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-1256
Practice Address - Country:US
Practice Address - Phone:814-454-5896
Practice Address - Fax:814-456-0037
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP005589B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PABU1784450OtherHIGHMARK
PA034113Medicare ID - Type UnspecifiedMEDICARE
PABU1784450OtherHIGHMARK