Healthcare Provider Details

I. General information

NPI: 1023144128
Provider Name (Legal Business Name): DENISE YVONNE BURNS LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DENISE YVONNE MARVIN LPN

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1576 STATE HIGHWAY 41
AFTON NY
13730
US

IV. Provider business mailing address

128 PLEASANTON DR
OTEGO NY
13825-2131
US

V. Phone/Fax

Practice location:
  • Phone: 607-639-5551
  • Fax:
Mailing address:
  • Phone: 607-988-2790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number200503-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: