Provider Demographics
NPI:1386617413
Name:BURNS, ELIZABETH EWING (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:EWING
Last Name:BURNS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 DRAPER ST
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-1710
Mailing Address - Country:US
Mailing Address - Phone:315-343-8714
Mailing Address - Fax:
Practice Address - Street 1:1 RUDOLPH ROAD SUNY OSWEGO
Practice Address - Street 2:WALKER HEALTH CENTER
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126
Practice Address - Country:US
Practice Address - Phone:315-312-4100
Practice Address - Fax:315-312-5409
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF300119363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS95393Medicare UPIN
NYBB8258Medicare ID - Type Unspecified