Provider Demographics
NPI:1801886254
Name:BURNS, SHANNON HAYNIE (FNP)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:HAYNIE
Last Name:BURNS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 FREE UNION RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-5601
Mailing Address - Country:US
Mailing Address - Phone:434-973-2501
Mailing Address - Fax:
Practice Address - Street 1:2901 FREE UNION RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-5601
Practice Address - Country:US
Practice Address - Phone:434-973-2501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024164925363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP84072Medicare UPIN
VAP84072Medicare UPIN