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NPI Code Detail

MEDICARE: NICOLE BURNS

MEDICARE: NICOLE BURNS
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
13747P1801XPersonal Care Attendant

General Provider Information

NPI Number : 1417165184
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE BURNS
Provider Business Mailing Address
First Line : 534 PARK AVE
Second Line :
City : LINCOLN PARK
State : MI
Zip : 48146-2624
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 19401 NORTHLINE RD
Second Line :
City : SOUTHGATE
State : MI
Zip : 48195-2277
Country : US
Telephone Number : 734-785-7718
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2007
Last Update Date : 07/08/2007

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Directions to “ NICOLE BURNS ” Practice Location

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