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General NPI Number Information
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NPI Number | 1609362961
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Entity Type | Individual
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Provider Name | MADELINE WILSON BURNS APRN
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Gender | Female
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Dates
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Enumeration Date | 07/10/2018
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Last Update Date | 03/04/2022
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Provider Practice Location Address
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Address Line | 401 6TH AVE
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City | MONTGOMERY
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State | WV
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Zip | 25136-2199
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Country | US
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Telephone | 304-442-5151
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Fax | 304-442-7494
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Provider Business Mailing Address
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Address Line | 286 ZANDALE DR
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City | LEXINGTON
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State | KY
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Zip | 40503-2660
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Country | US
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Telephone | 502-558-6669
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 106709
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 3012466
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License Number State | KY
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