Healthcare Provider Details

I. General information

NPI: 1144711466
Provider Name (Legal Business Name): ANDREA RENEE BURNS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2018
Last Update Date: 10/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7176 W RIDGE RD
FAIRVIEW PA
16415-2027
US

IV. Provider business mailing address

153 E 13TH ST STE 1300
ERIE PA
16503-1035
US

V. Phone/Fax

Practice location:
  • Phone: 814-474-3613
  • Fax: 814-474-3537
Mailing address:
  • Phone: 814-452-7781
  • Fax: 814-452-7005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN648943
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP018965
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: