Healthcare Provider Details

I. General information

NPI: 1891519187
Provider Name (Legal Business Name): JUDA BURNS BSN, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 N MAIN ST
PROVIDENCE RI
02904-5762
US

IV. Provider business mailing address

34 LITTLE COMFORT WAY
SOUTH KINGSTOWN RI
02879-4841
US

V. Phone/Fax

Practice location:
  • Phone: 401-276-4112
  • Fax:
Mailing address:
  • Phone: 212-796-5263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN80018
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: