Provider Demographics
NPI:1912697327
Name:BURNS, ANGEL MARIE (PROVIDER)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:MARIE
Last Name:BURNS
Suffix:
Gender:F
Credentials:PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 GRAND AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-5544
Mailing Address - Country:US
Mailing Address - Phone:248-979-0331
Mailing Address - Fax:
Practice Address - Street 1:50 GRAND AVE APT 3
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-5544
Practice Address - Country:US
Practice Address - Phone:248-979-0331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care