Healthcare Provider Details

I. General information

NPI: 1790094431
Provider Name (Legal Business Name): JESSICA ILYSE BURNS RN, MSN, WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2010
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6981 N PARK DR STE 300A
PENNSAUKEN NJ
08109-4205
US

IV. Provider business mailing address

301 LIPPINCOTT DR STE 410
MARLTON NJ
08053-4197
US

V. Phone/Fax

Practice location:
  • Phone: 856-854-4524
  • Fax: 856-365-7972
Mailing address:
  • Phone: 856-355-0340
  • Fax: 856-355-0330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number26NR14211700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number26NJ00305100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: