Provider Demographics
NPI:1972796126
Name:BURNS, DIANE LEE (NP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:LEE
Last Name:BURNS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8101 HINSON FARM RD
Mailing Address - Street 2:SUITE 408
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-3403
Mailing Address - Country:US
Mailing Address - Phone:703-780-9014
Mailing Address - Fax:703-780-9077
Practice Address - Street 1:8101 HINSON FARM RD
Practice Address - Street 2:SUITE 408
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3403
Practice Address - Country:US
Practice Address - Phone:703-780-9014
Practice Address - Fax:703-780-9077
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0017137410363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCP25267Medicare UPIN