Healthcare Provider Details

I. General information

NPI: 1508115841
Provider Name (Legal Business Name): AILEEN BURNS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2012
Last Update Date: 07/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3883 HWY 299
WILLOW CREEK CA
95573
US

IV. Provider business mailing address

670 9TH ST
ARCATA CA
95521-6248
US

V. Phone/Fax

Practice location:
  • Phone: 530-629-3111
  • Fax: 530-629-3122
Mailing address:
  • Phone: 707-826-8633
  • Fax: 707-826-8638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number822062
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number54514
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: