Provider Demographics
NPI:1760467757
Name:BURNES, MICHELE E (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:E
Last Name:BURNES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 N 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:VINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52349-2254
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1002 W MAIN ST
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IA
Practice Address - Zip Code:52345-9099
Practice Address - Country:US
Practice Address - Phone:319-443-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001211363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA17543OtherER GROUP #
IA55965OtherVFMC GROUP #
IA55965OtherVFMC GROUP #
IAS86305Medicare UPIN