Provider Demographics
NPI:1821328675
Name:BURNS, MICHELLE ANGELA (NP)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:ANGELA
Last Name:BURNS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 SANCHEZ ST
Mailing Address - Street 2:APT 3
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-1117
Mailing Address - Country:US
Mailing Address - Phone:415-867-4277
Mailing Address - Fax:
Practice Address - Street 1:2000 EMBARCADERO
Practice Address - Street 2:SUITE 400
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94606-5334
Practice Address - Country:US
Practice Address - Phone:510-567-8108
Practice Address - Fax:510-567-8108
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-29
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA566021363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics