Healthcare Provider Details

I. General information

NPI: 1790614147
Provider Name (Legal Business Name): EMMA MARIE BURNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18101 LORAIN AVE
CLEVELAND OH
44111-5612
US

IV. Provider business mailing address

11900 EDGEWATER DR APT 1108
LAKEWOOD OH
44107-1764
US

V. Phone/Fax

Practice location:
  • Phone: 216-476-7000
  • Fax:
Mailing address:
  • Phone: 614-485-8960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: