Provider Demographics
NPI:1881746949
Name:BURNS, BRENDA SHARON (MD)
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:SHARON
Last Name:BURNS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:B.
Other - Middle Name:SHARI
Other - Last Name:BURNS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4913 S 25TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68107-2756
Mailing Address - Country:US
Mailing Address - Phone:402-731-3553
Mailing Address - Fax:402-731-3343
Practice Address - Street 1:4913 S 25TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68107-2756
Practice Address - Country:US
Practice Address - Phone:402-731-3553
Practice Address - Fax:402-731-3343
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE18353174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEF31224Medicare UPIN