Provider Demographics
NPI:1487767414
Name:BURNS, DEANNA E (NP)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:E
Last Name:BURNS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60063
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0063
Mailing Address - Country:US
Mailing Address - Phone:704-302-8200
Mailing Address - Fax:704-302-8201
Practice Address - Street 1:3030 RANDOLPH RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1368
Practice Address - Country:US
Practice Address - Phone:704-302-8200
Practice Address - Fax:704-302-8201
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201125363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7004512Medicaid
NCP98504Medicare UPIN
NCNC6783NMedicare PIN
NCNC6783OMedicare PIN
NC2809463Medicare ID - Type Unspecified
NCNC6783KMedicare PIN
NCNC6783IMedicare PIN
NCNC6783LMedicare PIN
NCNC6783PMedicare PIN
NCNC6783QMedicare PIN
NCNC6783JMedicare PIN
NC7004512Medicaid
NCNC6783HMedicare PIN