Healthcare Provider Details

I. General information

NPI: 1992339279
Provider Name (Legal Business Name): ANGELA CATHERINE BURNS MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2020
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 FRANK SCOTT PARKWAY WEST SUITE 914
BELLEVILLE IL
62223
US

IV. Provider business mailing address

2900 FRANK SCOTT PKWY W STE 914
BELLEVILLE IL
62223-5000
US

V. Phone/Fax

Practice location:
  • Phone: 618-219-8634
  • Fax: 618-545-9040
Mailing address:
  • Phone: 618-219-8634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209020971
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209020971
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2020014286
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: