Provider Demographics
NPI:1184735623
Name:BURNS, STEPHEN M (RN FNP)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:M
Last Name:BURNS
Suffix:
Gender:M
Credentials:RN FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1351 ROUTE 55
Mailing Address - Street 2:SUITE101
Mailing Address - City:LAGRANGEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12540-5108
Mailing Address - Country:US
Mailing Address - Phone:845-475-9500
Mailing Address - Fax:845-475-9915
Practice Address - Street 1:1 COLUMBIA ST
Practice Address - Street 2:SUITE 200
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-3923
Practice Address - Country:US
Practice Address - Phone:845-473-1188
Practice Address - Fax:845-473-0896
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-12-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NYF333611363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02258217Medicaid
NY02258217Medicaid
NYA400095146Medicare PIN