Provider Demographics
NPI:1730323528
Name:BURNS, MARSHA SHENNUM (NP)
Entity type:Individual
Prefix:MRS
First Name:MARSHA
Middle Name:SHENNUM
Last Name:BURNS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 NE 139TH ST
Mailing Address - Street 2:SUITE 460
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-2309
Mailing Address - Country:US
Mailing Address - Phone:360-487-2727
Mailing Address - Fax:
Practice Address - Street 1:2101 NE 139TH ST
Practice Address - Street 2:SUITE 460
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-2309
Practice Address - Country:US
Practice Address - Phone:360-487-2727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-24
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA194415363LG0600X
NH050478-23363LG0600X
WA60399098-NP363LG0600X
OR201401568NP-PP363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology