Healthcare Provider Details

I. General information

NPI: 1437552387
Provider Name (Legal Business Name): MARLAINA BURNS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARLENE BURNS

II. Dates (important events)

Enumeration Date: 10/07/2014
Last Update Date: 06/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 QUINCY AVE
SCRANTON PA
18510-1120
US

IV. Provider business mailing address

930 QUINCY AVE
SCRANTON PA
18510-1120
US

V. Phone/Fax

Practice location:
  • Phone: 314-322-8384
  • Fax:
Mailing address:
  • Phone: 314-322-8384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP012782
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License NumberSP012782
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: