Provider Demographics
NPI:1427287218
Name:BURNS, DARLENE (PA)
Entity type:Individual
Prefix:
First Name:DARLENE
Middle Name:
Last Name:BURNS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:DARLENE
Other - Middle Name:
Other - Last Name:MCGOVERN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:114 5TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:MAYVILLE
Mailing Address - State:ND
Mailing Address - Zip Code:58257-1432
Mailing Address - Country:US
Mailing Address - Phone:210-383-6745
Mailing Address - Fax:
Practice Address - Street 1:1200 S COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4044
Practice Address - Country:US
Practice Address - Phone:701-780-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12931363A00000X
NDPAC0580363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDN720701Medicare PIN
NDN720700Medicare PIN