Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 224P00000X | Prosthetist |
NPI | 1013275445 |
---|---|
Provider Name | Ms. Dejuan Andrea Burns |
First Address | Clinton, MD 20735-2537 |
Second Address | Temple Hills, MD 20748-1405 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2012 |
Last Update Date | 12/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1457852600 | NPI (01) |