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NPI Code Detail

MEDICARE: MR. TIMOTHY DENNIS BURNS CRNA

MEDICARE: MR. TIMOTHY DENNIS BURNS CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse Anesthetist64846-030WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1114929676
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TIMOTHY DENNIS BURNS CRNA
Provider Business Mailing Address
First Line : 700 SUNNY LN
Second Line : PO BOX 555
City : RICHLAND CENTER
State : WI
Zip : 53581-1532
Country : US
Telephone Number : 608-647-2524
Fax Number :
Provider Business Practice Location Address
First Line : 333 E 2ND ST
Second Line :
City : RICHLAND CENTER
State : WI
Zip : 53581-1914
Country : US
Telephone Number : 608-647-6321
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2005
Last Update Date : 07/08/2007

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