Provider Demographics
NPI:1780128207
Name:BURNS, BRANDI NICOLE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:NICOLE
Last Name:BURNS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:BRANDI
Other - Middle Name:NICOLE
Other - Last Name:LOGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1517 POND ROAD
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104
Mailing Address - Country:US
Mailing Address - Phone:610-395-4444
Mailing Address - Fax:610-366-7886
Practice Address - Street 1:1517 POND ROAD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104
Practice Address - Country:US
Practice Address - Phone:610-395-4444
Practice Address - Fax:610-366-7886
Is Sole Proprietor?:No
Enumeration Date:2016-12-19
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA058804363AM0700X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical