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General NPI Number Information
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NPI Number | 1992790711
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Entity Type | Individual
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Provider Name | JILL BURNS
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Gender | Female
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Dates
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Enumeration Date | 09/19/2005
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Last Update Date | 04/06/2021
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Provider Practice Location Address
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Address Line | 103 WEST AVE SUITE 203
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City | WELLSBORO
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State | PA
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Zip | 16901-1311
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Country | US
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Telephone | 570-724-3744
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Fax |
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Provider Business Mailing Address
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Address Line | 32-36 CENTRAL AVE SUITE 203
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City | WELLSBORO
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State | PA
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Zip | 16901-1840
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Country | US
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Telephone |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD073885L
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License Number State | PA
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