MEDICARE: SANDRA KAY BURNS RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	28066005A	IN

General Provider Information

NPI Number	:	1548206667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA KAY BURNS RN

Provider Business Mailing Address
First Line	:	515 BAYOU ST
Second Line	:
City	:	VINCENNES
State	:	IN
Zip	:	47591-1034
Country	:	US
Telephone Number	:	812-886-6800
Fax Number	:	812-886-6809

Provider Business Practice Location Address
First Line	:	2007 STATE ST
Second Line	:
City	:	WASHINGTON
State	:	IN
Zip	:	47501-8505
Country	:	US
Telephone Number	:	812-254-1558
Fax Number	:	812-254-8308

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	01/04/2008

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