Provider Demographics
NPI:1811997455
Name:BURNS, DEBORAH (CNP)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:BURNS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:RUBEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:PO BOX 423
Mailing Address - Street 2:
Mailing Address - City:CHANHASSEN
Mailing Address - State:MN
Mailing Address - Zip Code:55317-0423
Mailing Address - Country:US
Mailing Address - Phone:952-934-0570
Mailing Address - Fax:952-906-7837
Practice Address - Street 1:7907 POWERS BLVD
Practice Address - Street 2:
Practice Address - City:CHANHASSEN
Practice Address - State:MN
Practice Address - Zip Code:55317-9502
Practice Address - Country:US
Practice Address - Phone:952-934-0570
Practice Address - Fax:952-906-7837
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1169801363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNR1169801OtherRN LICENSE
MNP11728Medicare UPIN