Provider Demographics
NPI:1891194403
Name:BURNS, MILISSA ELLEN (RN, PHN)
Entity Type:Individual
Prefix:
First Name:MILISSA
Middle Name:ELLEN
Last Name:BURNS
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1173 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-3904
Mailing Address - Country:US
Mailing Address - Phone:619-615-2454
Mailing Address - Fax:619-615-2450
Practice Address - Street 1:1173 FRONT ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-3904
Practice Address - Country:US
Practice Address - Phone:619-615-2454
Practice Address - Fax:619-615-2450
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA816243163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse