Healthcare Provider Details

I. General information

NPI: 1437252996
Provider Name (Legal Business Name): AUGUST BURNS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 04/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 EAST MAIN STREET
HYDE PARK VT
05655
US

IV. Provider business mailing address

108 NO SWAMP ROAD
NO MIDDLESEX VT
05862
US

V. Phone/Fax

Practice location:
  • Phone: 802-888-3077
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number055-0030036
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: