MEDICARE: ELIZABETH BURNS NP

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
1	363LW0102X	Women's Health Nurse Practitioner	28088212A	IN
2	364SW0102X	Women's Health Clinical Nurse Specialist	193893-5	MN

General Provider Information

NPI Number	:	1396747937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH BURNS NP

Provider Business Mailing Address
First Line	:	PO BOX 29279
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46229-0279
Country	:	US
Telephone Number	:	317-523-9408
Fax Number	:

Provider Business Practice Location Address
First Line	:	470 W 78TH ST
Second Line	:	SUITE 250
City	:	CHANHASSEN
State	:	MN
Zip	:	55317-4524
Country	:	US
Telephone Number	:	800-955-8346
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	08/02/2010

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