Provider Demographics
NPI:1427272269
Name:BURNES, HOLLY G (APRN,BC)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:G
Last Name:BURNES
Suffix:
Gender:F
Credentials:APRN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 HEATH ST
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-2820
Mailing Address - Country:US
Mailing Address - Phone:617-277-9007
Mailing Address - Fax:617-739-7232
Practice Address - Street 1:359 HEATH ST
Practice Address - Street 2:
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-2820
Practice Address - Country:US
Practice Address - Phone:617-277-9007
Practice Address - Fax:617-739-7232
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA106582163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPN0797OtherBLUE CROSS, BLUE SHIELD
MANSO665Medicare ID - Type Unspecified