Provider Demographics
NPI:1700889722
Name:BURNS, CHRISTOPHER D (NP)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:D
Last Name:BURNS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4137 S TURNING LEAF CT
Mailing Address - Street 2:
Mailing Address - City:NEW PALESTINE
Mailing Address - State:IN
Mailing Address - Zip Code:46163-8652
Mailing Address - Country:US
Mailing Address - Phone:317-354-5674
Mailing Address - Fax:
Practice Address - Street 1:4137 S TURNING LEAF CT
Practice Address - Street 2:
Practice Address - City:NEW PALESTINE
Practice Address - State:IN
Practice Address - Zip Code:46163-8652
Practice Address - Country:US
Practice Address - Phone:317-354-5674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INF0404180174400000X, 363LF0000X
IN71001778A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000342506OtherANTHEM PROVIDER NUMBER
INF0404180OtherNP LICENSE NUMBER
IN000000342506OtherANTHEM PROVIDER NUMBER
INF0404180OtherNP LICENSE NUMBER