Provider Demographics
NPI:1023144128
Name:BURNS, DENISE YVONNE (LPN)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:YVONNE
Last Name:BURNS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:DENISE
Other - Middle Name:YVONNE
Other - Last Name:MARVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:128 PLEASANTON DR
Mailing Address - Street 2:
Mailing Address - City:OTEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13825-2131
Mailing Address - Country:US
Mailing Address - Phone:607-988-2790
Mailing Address - Fax:
Practice Address - Street 1:1576 STATE HIGHWAY 41
Practice Address - Street 2:
Practice Address - City:AFTON
Practice Address - State:NY
Practice Address - Zip Code:13730
Practice Address - Country:US
Practice Address - Phone:607-639-5551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200503-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse