Provider Demographics
NPI:1902846199
Name:BURHANNA, PATRICIA (ANP, RN)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:BURHANNA
Suffix:
Gender:F
Credentials:ANP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2516 MASCOUTAH AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220-3468
Mailing Address - Country:US
Mailing Address - Phone:618-233-4200
Mailing Address - Fax:
Practice Address - Street 1:2516 MASCOUTAH AVE
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-3468
Practice Address - Country:US
Practice Address - Phone:618-233-4200
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK06673Medicare ID - Type UnspecifiedMEDICARE NUMBER